Provider Demographics
NPI:1568489581
Name:GULLAPALLI, SATYA (MD)
Entity Type:Individual
Prefix:
First Name:SATYA
Middle Name:
Last Name:GULLAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 CYPRESS VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6834
Mailing Address - Country:US
Mailing Address - Phone:813-634-5858
Mailing Address - Fax:813-633-1349
Practice Address - Street 1:13142 ELK MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7182
Practice Address - Country:US
Practice Address - Phone:813-634-5858
Practice Address - Fax:813-633-1349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAME0093900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37006OtherBCBS PIN
P00696717OtherRAILROAD MEDICARE
FL37006OtherBCBS PIN