Provider Demographics
NPI:1063498327
Name:SABAPATHY, MUDANAI PANNEERSELVAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MUDANAI
Middle Name:PANNEERSELVAM
Last Name:SABAPATHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-473-8613
Mailing Address - Fax:321-914-0229
Practice Address - Street 1:3044 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3566
Practice Address - Country:US
Practice Address - Phone:321-473-8613
Practice Address - Fax:321-914-0229
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3956149OtherAETNA
FL7370660OtherAETNA
FL9699993002OtherCIGNA
FL16559OtherBLUE CROSS BLUE SHIELD
FL294728OtherWELLCARE
FL273009000Medicaid
FL294728OtherWELLCARE
FL273009000Medicaid