Provider Demographics
NPI:1154551992
Name:KURUSANGANAPALLI, NAGAMANI (MD)
Entity type:Individual
Prefix:DR
First Name:NAGAMANI
Middle Name:
Last Name:KURUSANGANAPALLI
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 1:7137 N US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5094
Mailing Address - Country:US
Mailing Address - Phone:321-632-3500
Mailing Address - Fax:321-690-2610
Practice Address - Street 1:5005 PORT ST JOHN PKWY STE 2500
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-504-0556
Practice Address - Fax:321-504-0773
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006247400Medicaid