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General NPI Number Information
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NPI Number | 1043763261
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Entity Type | Organization
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Legal Business Name | SUNIL AYYAGARI MD PLLC
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 824 NE 19TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3081
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Country | US
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Telephone | 309-472-6669
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Fax |
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Provider Business Mailing Address
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Address Line | 824 NE 19TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3081
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Country | US
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Telephone | 309-472-6669
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SUNIL AYYAGARI
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Credential | MD
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Telephone | 309-472-6669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 97865
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License Number State | FL
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