Provider Demographics
NPI:1427081918
Name:DEVARAKONDA, SUBRAHMANYAM (MD)
Entity type:Individual
Prefix:DR
First Name:SUBRAHMANYAM
Middle Name:
Last Name:DEVARAKONDA
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 1:1507 W REYNOLD ST
Mailing Address - Street 2:STE B
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563
Mailing Address - Country:US
Mailing Address - Phone:813-752-1053
Mailing Address - Fax:813-754-6739
Practice Address - Street 1:1507 W REYNOLDS ST
Practice Address - Street 2:STE B
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4702
Practice Address - Country:US
Practice Address - Phone:813-752-1053
Practice Address - Fax:813-754-6739
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06845OtherWELLCARE
FL30347OtherBCBS
FL110046857OtherRAILROAD
FL205531OtherAVMED
FL30347OtherBCBS
FLD53948Medicare UPIN