Healthcare Provider Details

I. General information

NPI: 1790770360
Provider Name (Legal Business Name): AMARAVADI & AMARAVADI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 LITTLE ROAD
TRINITY FL
34655-1811
US

IV. Provider business mailing address

3535 LITTLE ROAD
TRINITY FL
34655-1811
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-0848
  • Fax: 727-375-5548
Mailing address:
  • Phone: 727-375-0848
  • Fax: 727-375-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number038311
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SIVAKUMAR V AMARAVADI
Title or Position: MD
Credential: MD
Phone: 727-375-0848