Provider Demographics
NPI:1427279611
Name:HANSALIA, SUDHIR (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:
Last Name:HANSALIA
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 1:5000 PARK ST N STE 1017
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2236
Mailing Address - Country:US
Mailing Address - Phone:727-344-6570
Mailing Address - Fax:727-384-4388
Practice Address - Street 1:3611 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1813
Practice Address - Country:US
Practice Address - Phone:727-312-4300
Practice Address - Fax:727-413-4335
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114725207RH0003X
IL036120466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018165100OtherFLORIDA MEDICAID ID
FLKX084OtherMEDICARE
FLKX085OtherMEDICARE
FL6VBQROtherBCBS FL
FL8528341Medicaid