Healthcare Provider Details

I. General information

NPI: 1528300548
Provider Name (Legal Business Name): SUJAL KOTADIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 GALL BLVD STE 204
ZEPHYRHILLS FL
33542-2569
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-1147
  • Fax: 813-355-5056
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME130876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: