Healthcare Provider Details

I. General information

NPI: 1578564811
Provider Name (Legal Business Name): SANTHARAM V NALLAMSHETTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 S US 301
SUMTERVILLE FL
33585-5143
US

IV. Provider business mailing address

1425 S US 301
SUMTERVILLE FL
33585-5141
US

V. Phone/Fax

Practice location:
  • Phone: 352-793-5900
  • Fax: 352-793-9558
Mailing address:
  • Phone: 352-793-5900
  • Fax: 352-793-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME 82800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: