Healthcare Provider Details

I. General information

NPI: 1629208509
Provider Name (Legal Business Name): SVETA MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2009
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E DR MARTIN LUTHER KING JR BLVD 112
TAMPA FL
33603-3932
US

IV. Provider business mailing address

3301 BAYSHORE BLVD UNIT 2207B
TAMPA FL
33629-8840
US

V. Phone/Fax

Practice location:
  • Phone: 813-229-6139
  • Fax:
Mailing address:
  • Phone: 718-483-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME112476
License Number StateFL

VIII. Authorized Official

Name: DR. DURGA P CHINTAKAYALA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 813-324-7029