Healthcare Provider Details

I. General information

NPI: 1487877346
Provider Name (Legal Business Name): MALAY SURESH GANDHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5398 PARK ST N
ST PETERSBURG FL
33709-1041
US

IV. Provider business mailing address

5398 PARK ST N
ST PETERSBURG FL
33709-1041
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-1441
  • Fax: 727-545-8263
Mailing address:
  • Phone: 727-544-1441
  • Fax: 727-545-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME116350
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME116350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: