Provider Demographics
NPI:1902907546
Name:IYYUNNI, UJWALA R (MD)
Entity Type:Individual
Prefix:
First Name:UJWALA
Middle Name:R
Last Name:IYYUNNI
Suffix:
Gender:F
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:PO BOX 24535
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33623-4535
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:
Practice Address - Street 1:8999 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5811
Practice Address - Country:US
Practice Address - Phone:727-576-9999
Practice Address - Fax:727-576-5606
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110221946OtherRR MCR LOC 2
FL43562OtherBLUE CROSS
FLP00658955OtherRR MCR LOC 1
FL253567000Medicaid
FL43562OtherBLUE CROSS
FL110221946OtherRR MCR LOC 2