Individual
AMY VIDWANS PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1755 N FLORIDA AVE, LAKELAND, FL 33805-3109
(863) 904-6201
(866) 264-8519
Mailing address
1600 LAKELAND HILLS BLVD, LAKELAND, FL 33805-3019
(863) 680-7000
(866) 264-8519
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME95029
FL
207ND0900X
Dermatopathology Physician
ME95029
FL
Other
Enumeration date
11/09/2006
Last updated
11/27/2023
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