Provider Demographics
NPI:1083606453
Name:EMANDI, VENKATA RAO (MD)
Entity Type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:RAO
Last Name:EMANDI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14690 SPRING HILL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:14535 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-596-3622
Practice Address - Fax:352-596-0901
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2018-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME00400432085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08116OtherBLUE CROSS BLUE SHIELD
FL372038100Medicaid
FL08116XMedicare PIN