Basic Information
| Provider Information | |||||||||
| NPI: | 1427279611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSALIA | ||||||||
| FirstName: | SUDHIR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 PARK ST N STE 1017 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446570 | ||||||||
| FaxNumber: | 7273844388 | ||||||||
| Practice Location | |||||||||
| Address1: | 3611 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | TRINITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346551813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273124300 | ||||||||
| FaxNumber: | 7274134335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME114725 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 018165100 | 01 | FL | FLORIDA MEDICAID ID | OTHER | KX084 | 01 | FL | MEDICARE | OTHER | KX085 | 01 | FL | MEDICARE | OTHER | 6VBQR | 01 | FL | BCBS FL | OTHER | 8528341 | 05 | FL | MEDICAID |