Individual
DR. VIDYASAGAR REDDY VANGALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2504 SAND MINE RD, DAVENPORT, FL 33897-3402
(863) 419-7645
(863) 419-7655
Mailing address
1 SOUTH BLVD E # 1020, DAVENPORT, FL 33837-7547
(863) 419-7645
(863) 419-7655
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME82811
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267311800
—
FL
01
—
79180
PTAN
—
Enumeration date
09/12/2005
Last updated
06/07/2024
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