Provider Demographics
NPI:1336107622
Name:POLASA, SANGEETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANGEETHA
Middle Name:
Last Name:POLASA
Suffix:
Gender:F
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 1:917 RINEHART RD
Mailing Address - Street 2:STE 1051
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4853
Mailing Address - Country:US
Mailing Address - Phone:407-647-2346
Mailing Address - Fax:
Practice Address - Street 1:2180 W STATE ROAD 434
Practice Address - Street 2:SUITE 2110
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5041
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:407-277-7152
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 91590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU79382Medicare PIN