Provider Demographics
NPI:1326014242
Name:MANAPRAGADA, SIVARAO (MD)
Entity Type:Individual
Prefix:
First Name:SIVARAO
Middle Name:
Last Name:MANAPRAGADA
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 1:555 W STATE ROAD 434
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5119
Mailing Address - Country:US
Mailing Address - Phone:321-842-2994
Mailing Address - Fax:407-767-5801
Practice Address - Street 1:555 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5119
Practice Address - Country:US
Practice Address - Phone:321-842-2994
Practice Address - Fax:407-767-5801
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270171500Medicaid
FL37907OtherBCBS
FL37907OtherBCBS