Provider Demographics
NPI:1659551356
Name:HUNDAE, ANELEY YEGEZU (MD)
Entity Type:Individual
Prefix:
First Name:ANELEY
Middle Name:YEGEZU
Last Name:HUNDAE
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 1:3161 HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6754
Mailing Address - Country:US
Mailing Address - Phone:941-235-8892
Mailing Address - Fax:941-883-4494
Practice Address - Street 1:3161 HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6754
Practice Address - Country:US
Practice Address - Phone:941-235-8892
Practice Address - Fax:941-883-4494
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106485207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101320800Medicaid
FLEH094VMedicare PIN