Provider Demographics
NPI:1588606354
Name:PRADHAN, SANDEEP K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:K
Last Name:PRADHAN
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:PO BOX 2216
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34697-6612
Mailing Address - Country:US
Mailing Address - Phone:727-734-6932
Mailing Address - Fax:727-734-4516
Practice Address - Street 1:646 VIRGINIA ST. 421
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-734-6932
Practice Address - Fax:727-734-4516
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85465207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263932700Medicaid
FLG88153Medicare UPIN
FL18005ZMedicare ID - Type Unspecified