Healthcare Provider Details

I. General information

NPI: 1053307488
Provider Name (Legal Business Name): SUMESH CHANDRA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 BRUCE B DOWNS BLVD STE 201
TAMPA FL
33613-3937
US

IV. Provider business mailing address

13801 BRUCE B DOWNS BLVD STE 201
TAMPA FL
33613-3937
US

V. Phone/Fax

Practice location:
  • Phone: 813-977-5557
  • Fax: 813-972-9211
Mailing address:
  • Phone: 813-977-5557
  • Fax: 813-972-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME0034899
License Number StateFL

VIII. Authorized Official

Name: SUMESH CHANDRA
Title or Position: OWNER - PRESIDENT
Credential: MD
Phone: 813-977-5557