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General NPI Number Information
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NPI Number | 1669737706
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Entity Type | Individual
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Provider Name | VAMSI NUKALA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2012
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 1501 S PINELLAS AVE STE G
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1950
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Country | US
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Telephone | 727-943-3405
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 S PINELLAS AVE STE G
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-1950
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Country | US
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Telephone | 727-943-3405
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35125917
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036.142028
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME156034
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License Number State | FL
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