MEDICARE: DR. VENKATACHALAM SHANMUGASUNDARAM MD

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	207Y00000X	Otolaryngology Physician	ME0045705	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00446	OTHER	FL	WELLCARE
2	3370WELL	OTHER	FL	NIEGHBORHOOD PATNERS
3	592607590	OTHER	FL	CHAMPUS
4	0067235	OTHER	FL	GHI
5	1002118	OTHER	FL	UNITED HEALTHCARE
6	3370WELL	OTHER	FL	NEIGHBORHOOD PARTNERS
7	00446	OTHER	FL	STAYWELL
8	592607590	OTHER	FL	VISTA
9	205868	OTHER	FL	AMERIGROUP
10	61449	OTHER	FL	BLUE CROSS BLUE SHIELD
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	0854223	OTHER	FL	AETNA
13	592607590A	OTHER	FL	HUMANA

General Provider Information

NPI Number	:	1821083031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATACHALAM SHANMUGASUNDARAM MD

Provider Business Mailing Address
First Line	:	10131 W FOREST HILL BLVD STE 201
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6109
Country	:	US
Telephone Number	:	561-798-6767
Fax Number	:	561-795-2706

Provider Business Practice Location Address
First Line	:	10131 W FOREST HILL BLVD
Second Line	:	SUITE 201
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6156
Country	:	US
Telephone Number	:	561-798-6767
Fax Number	:	561-795-2706

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/24/2020

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