Individual
VENKAT PAVAN REDDY KANCHARLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
20 SAN FILIPPO DR SE, PALM BAY, FL 32909-2200
(321) 725-8300
(321) 725-1555
Mailing address
PO BOX 534595, ATLANTA, GA 30353-4595
(321) 725-8300
(321) 725-1555
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
ME112590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004704200
—
FL
Enumeration date
07/24/2008
Last updated
01/07/2019
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