Provider Demographics
NPI:1124204763
Name:VELAGAPUDI, SATISH (MD)
Entity Type:Individual
Prefix:DR
First Name:SATISH
Middle Name:
Last Name:VELAGAPUDI
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 1:3400 TAMIAMI TRL
Mailing Address - Street 2:BLGD 2 STE 203
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-500-2155
Mailing Address - Fax:941-500-2154
Practice Address - Street 1:3400 TAMIAMI TRL STE 203
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-500-2155
Practice Address - Fax:941-500-2154
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141578207RC0000X, 207RC0001X
TXR3612207RC0000X
NH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124204763Medicaid
683750653Medicare PIN