Provider Demographics
NPI:1700041282
Name:GANGINA, SUMALATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMALATHA
Middle Name:
Last Name:GANGINA
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 1:4354 DUCK DOWN LN
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3293
Mailing Address - Country:US
Mailing Address - Phone:863-968-3635
Mailing Address - Fax:863-638-5722
Practice Address - Street 1:2243 NORTH BLVD W
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8990
Practice Address - Country:US
Practice Address - Phone:863-353-1394
Practice Address - Fax:863-638-5722
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101106207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine