Healthcare Provider Details

I. General information

NPI: 1962459156
Provider Name (Legal Business Name): DAKSHINA N B WALGAMPAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W KENNEDY BLVD
TAMPA FL
33609-3305
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-1385
  • Fax: 813-254-0230
Mailing address:
  • Phone: 813-844-8927
  • Fax: 813-844-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD433531
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9827
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME121730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: