Provider Demographics
NPI:1770535700
Name:KALMADI, SAHANA R (MD)
Entity type:Individual
Prefix:
First Name:SAHANA
Middle Name:R
Last Name:KALMADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 AC SKINNER PARKWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-363-7453
Mailing Address - Fax:904-538-3672
Practice Address - Street 1:14546 OLD SAINT AUGUSTINE RD STE 317
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5472
Practice Address - Country:US
Practice Address - Phone:904-260-9445
Practice Address - Fax:904-260-0005
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92400207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01521OtherBCBS
FL296866OtherAVMED
FL7449667OtherAETNA
FL271925800Medicaid
FL01521WMedicare PIN
FL01521OtherBCBS
FL271925800Medicaid
FL01521XMedicare PIN
FL01521VMedicare PIN