Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | ME 35585 | FL |
NPI | 1285836114 |
---|---|
Provider Name | Shankara B Mangipudy |
First Address | Saint Petersburg, FL 33733 |
Second Address | Saint Petersburg, FL 33733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |