Healthcare Provider Details

I. General information

NPI: 1417156944
Provider Name (Legal Business Name): AMOD SARNAIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2007
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR SRB-4
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR SRB-4
TAMPA FL
33612-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-8581
  • Fax: 813-745-5725
Mailing address:
  • Phone: 813-745-8581
  • Fax: 813-745-5725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberTRN9920
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME100184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: