Provider Demographics
NPI:1467405209
Name:SANDRAPATY, RAVICHANDRA KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVICHANDRA
Middle Name:KUMAR
Last Name:SANDRAPATY
Suffix:
Gender:M
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3201 SW 33RD RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-291-2495
Practice Address - Fax:352-291-2498
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00852002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265856400Medicaid
FL5841735OtherAETNA
FLP01254192OtherRAILROAD MCR
FL3375149OtherCIGNA
FL62699OtherBCBS OF FL
FLP00161OtherFREEDOM HEALTH
FLP502639Medicaid
FL282779OtherWELLCARE
FL284645OtherAVMED
FL62699OtherBCBS
FLP203602OtherOPTIMUM
FLP502639Medicaid
FLE7795YMedicare PIN
FLE7795WMedicare PIN
FL3375149OtherCIGNA
FLE7795XMedicare PIN