Provider Demographics
NPI:1316384241
Name:KANDASAMY, UMASHANKAR (MD)
Entity Type:Individual
Prefix:
First Name:UMASHANKAR
Middle Name:
Last Name:KANDASAMY
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 1:660 E 98TH ST APT 11C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1350
Mailing Address - Country:US
Mailing Address - Phone:732-610-7309
Mailing Address - Fax:
Practice Address - Street 1:12136 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:BAYONET POINT
Practice Address - State:FL
Practice Address - Zip Code:34667-2432
Practice Address - Country:US
Practice Address - Phone:352-584-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 115533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics