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General NPI Number Information
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NPI Number | 1720061674
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Entity Type | Individual
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Provider Name | SUNDERAM KODMAN SHETTY M.D., F.A.C.R.O.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 901 45TH ST KAPLAN CANCER CENTER, ST MARYS HOSPITAL
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2413
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Country | US
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Telephone | 561-881-2815
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Fax | 561-881-0951
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Provider Business Mailing Address
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Address Line | 901 45TH ST KAPLAN CANCER CENTER, ST MARYS HOSPITAL
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2413
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Country | US
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Telephone | 561-881-2815
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Fax | 561-881-0951
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME37893
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License Number State | FL
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