Provider Demographics
NPI:1023217825
Name:VAIKUNTH, SACHIN SUDMIR (MD)
Entity Type:Individual
Prefix:
First Name:SACHIN
Middle Name:SUDMIR
Last Name:VAIKUNTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 FOREST AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2612
Mailing Address - Country:US
Mailing Address - Phone:727-375-2849
Mailing Address - Fax:727-266-4915
Practice Address - Street 1:6633 FOREST AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-375-2849
Practice Address - Fax:727-266-4915
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD47892208600000X
FLME118760208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526000Medicaid
TN1526000Medicaid