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General NPI Number Information
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NPI Number | 1447870977
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Entity Type | Organization
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Legal Business Name | SHANMUGASUNDARAM, VENKATACHALAM
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 10131 W FOREST HILL BLVD STE 201
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City | WELLINGTON
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State | FL
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Zip | 33414-6109
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Country | US
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Telephone | 561-798-6767
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Fax | 561-795-2706
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Provider Business Mailing Address
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Address Line | 10131 W FOREST HILL BLVD STE 201
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City | WELLINGTON
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State | FL
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Zip | 33414-6109
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Country | US
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Telephone | 561-798-6767
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Fax | 561-795-2706
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Authorized Official
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Title or Position | DOCTOR OF MEDICINE
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Name | DR. V S SUNDARAM
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Credential | MD
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Telephone | 561-798-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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