Provider Demographics
NPI:1255951380
Name:WADHWA, SANJU RITI (MD)
Entity type:Individual
Prefix:
First Name:SANJU
Middle Name:RITI
Last Name:WADHWA
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 1:7969 STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3120
Mailing Address - Country:US
Mailing Address - Phone:772-812-7272
Mailing Address - Fax:
Practice Address - Street 1:7969 STEEPLECHASE CT
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3120
Practice Address - Country:US
Practice Address - Phone:772-812-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164156207RA0401X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine