Healthcare Provider Details

I. General information

NPI: 1427279611
Provider Name (Legal Business Name): SUDHIR HANSALIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 LITTLE RD
TRINITY FL
34655-1813
US

IV. Provider business mailing address

5000 PARK ST N STE 1017
ST PETERSBURG FL
33709-2236
US

V. Phone/Fax

Practice location:
  • Phone: 727-312-4300
  • Fax: 727-413-4335
Mailing address:
  • Phone: 727-344-6570
  • Fax: 727-384-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME114725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: