Provider Demographics
NPI:1841211851
Name:AYYAGARI, SUNIL (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:AYYAGARI
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 1:1500 E HILLSBORO BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:954-428-2480
Mailing Address - Fax:954-428-2904
Practice Address - Street 1:1500 N UNIVERSITY DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071
Practice Address - Country:US
Practice Address - Phone:954-428-2480
Practice Address - Fax:954-428-2904
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 97865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277787800Medicaid
FL277787800Medicaid
ILI45114Medicare UPIN
IL623665OtherHEALTHLINK
ILK22549Medicare ID - Type Unspecified
IL0361141631Medicaid