Provider Demographics
NPI:1952501454
Name:BALULAD, SUJATA SHANKARAPPA (MD)
Entity Type:Individual
Prefix:MS
First Name:SUJATA
Middle Name:SHANKARAPPA
Last Name:BALULAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:33041 PROFESSIONAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3761
Mailing Address - Country:US
Mailing Address - Phone:352-478-0010
Mailing Address - Fax:949-577-4163
Practice Address - Street 1:33041 PROFESSIONAL DR STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3761
Practice Address - Country:US
Practice Address - Phone:321-632-6963
Practice Address - Fax:321-632-6983
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003280207Q00000X, 208M00000X
MA234022208M00000X
FLME131641207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist