Healthcare Provider Details

I. General information

NPI: 1477547602
Provider Name (Legal Business Name): SUMESH CHANDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SUMESH CHANDRA MD

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
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:
Title or Position:
Credential:
Phone: