Provider Demographics
NPI:1649284076
Name:RADIATION ONCOLOGY SPECIALISTS OF THE PALM BEACHES, L.L.C.
Entity type:Organization
Organization Name:RADIATION ONCOLOGY SPECIALISTS OF THE PALM BEACHES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDERAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-714-1397
Mailing Address - Street 1:PO BOX 31477
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-1477
Mailing Address - Country:US
Mailing Address - Phone:561-626-7223
Mailing Address - Fax:561-626-6146
Practice Address - Street 1:901 45TH ST
Practice Address - Street 2:KAPLAN CANCER CENTER
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2413
Practice Address - Country:US
Practice Address - Phone:561-881-2815
Practice Address - Fax:561-626-6146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74641OtherBLUE CROSS/BLUE SHIELD
FL269509000Medicaid
FL74641OtherBLUE CROSS/BLUE SHIELD