MEDICARE: DR. SUKHENDER R SINGIREDDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME0081395	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00387686	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013973882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUKHENDER R SINGIREDDY M.D.

Provider Business Mailing Address
First Line	:	880 RIVERSIDE DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-7851
Country	:	US
Telephone Number	:	386-677-6928
Fax Number	:	386-304-3135

Provider Business Practice Location Address
First Line	:	1728 DUNLAWTON AVE
Second Line	:	STE 5
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2922
Country	:	US
Telephone Number	:	386-304-3404
Fax Number	:	386-304-3135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	01/25/2012

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