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General NPI Number Information
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NPI Number | 1528682259
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Entity Type | Individual
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Provider Name | SANJANA THOTA-KAMMILI MBBS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 120 PINNACLES DR STE 1
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City | PALM COAST
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State | FL
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Zip | 32164-2322
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Country | US
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Telephone | 386-231-6549
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Fax | 386-231-6550
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Provider Business Mailing Address
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Address Line | 770 W GRANADA BLVD STE 101
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5179
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME161327
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License Number State | FL
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