Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301084093 | MI |
N | 111NI0900X | Internist | 4301084093 | MI |
N | 207RH0003X | Hematology & Oncology | 4301084093 | MI |
Y | 207RH0003X | Hematology & Oncology | ME132894 | FL |
NPI | 1023227691 |
---|---|
Provider Name | Dr. Hema Madhavi Vankayala |
First Address | Jacksonville, FL 32256-6932 |
Second Address | Fleming Island, FL 32003-4326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021329800 | (05) | FL |
JA165Z | MEDICARE (01) | FL |
NBBWU | BCBS (01) | FL |