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General NPI Number Information
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NPI Number | 1366639957
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Entity Type | Individual
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Provider Name | SHOBHA SUBRAMANIAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 1580 SANTA BARBARA BLVD
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City | THE VILLAGES
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State | FL
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Zip | 32159-6827
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Country | US
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Telephone | 352-259-2159
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 S DOUGLAS RD STE 308
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City | CORAL GABLES
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State | FL
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Zip | 33134-6134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 081582
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME150205
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License Number State | FL
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