Provider Demographics
NPI:1790533487
Name:SANDRUGU, JOEL SUKUMAR (MBBS)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:SUKUMAR
Last Name:SANDRUGU
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MAR WALT DR. FORT WALTON BEACH
Mailing Address - Street 2:HCA FLORIDA FORT WALTON-DESTIN HOSPITAL
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-969-4500
Mailing Address - Fax:
Practice Address - Street 1:1000 MAR WALT DR. FORT WALTON BEACH
Practice Address - Street 2:HCA FLORIDA FORT WALTON-DESTIN HOSPITAL
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-969-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program