Provider Demographics
NPI:1336161686
Name:VARADARAJULU, SHYAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:SHYAM
Middle Name:S
Last Name:VARADARAJULU
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 1:701 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4814
Mailing Address - Country:US
Mailing Address - Phone:321-842-2431
Mailing Address - Fax:321-842-3651
Practice Address - Street 1:701 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4814
Practice Address - Country:US
Practice Address - Phone:321-842-2431
Practice Address - Fax:321-842-3651
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110834207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005487300Medicaid
AL051516802OtherBLUE CROSS
AL051553734Medicaid
AL106730Medicaid
ALP00026444OtherRAILROAD MEDICARE
AL051553734Medicare ID - Type Unspecified
AL126120Medicaid
AL010033CH39360OtherSECTION 1011
AL051595503OtherBLUE CROSS
MS03279249Medicaid
AL009925425Medicaid