Provider Demographics
NPI:1588697080
Name:IYUNNI, VENKATA SSN (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:SSN
Last Name:IYUNNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IVS
Other - Middle Name:
Other - Last Name:NATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6217 66TH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5233
Mailing Address - Country:US
Mailing Address - Phone:727-546-1680
Mailing Address - Fax:727-548-0965
Practice Address - Street 1:6217 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-546-1680
Practice Address - Fax:727-546-9746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047362174400000X
FLME47362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110020799OtherRAILROAD MCR
FL065241500Medicaid
FL62596XMedicare PIN
FL065241500Medicaid
FLD65385Medicare UPIN
D65385Medicare UPIN