Provider Demographics
NPI:1174575732
Name:SINNATAMBY, DIANE S (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:S
Last Name:SINNATAMBY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 900
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4753
Practice Address - Country:US
Practice Address - Phone:904-381-9651
Practice Address - Fax:904-389-9319
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
VA0101237121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
VABS8767456OtherDEA