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General NPI Number Information
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NPI Number | 1700041282
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Entity Type | Individual
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Provider Name | SUMALATHA GANGINA M.D
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Gender | Female
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 2243 NORTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-8990
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Country | US
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Telephone | 863-353-1394
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Fax | 863-638-5722
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Provider Business Mailing Address
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Address Line | 4354 DUCK DOWN LN
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3293
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Country | US
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Telephone | 863-968-3635
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Fax | 863-638-5722
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME101106
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License Number State | FL
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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 | ME101106
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License Number State | FL
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