Provider Demographics
NPI:1184605404
Name:SAMBANDAM, ODAIYAPPA (MD, FACC FCCP)
Entity type:Individual
Prefix:
First Name:ODAIYAPPA
Middle Name:
Last Name:SAMBANDAM
Suffix:
Gender:M
Credentials:MD, FACC FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5052
Mailing Address - Country:US
Mailing Address - Phone:941-627-0323
Mailing Address - Fax:941-627-3853
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-627-0323
Practice Address - Fax:941-627-3853
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33947207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51974Medicare UPIN
FL08087Medicare ID - Type Unspecified