Individual
DR. BHASKAR NANDIMANDALAM RAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2345 SAND LAKE RD, SUITE 200, ORLANDO, FL 32809-9142
(407) 851-5121
(407) 851-0439
Mailing address
2345 SAND LAKE RD, SUITE 200, ORLANDO, FL 32809-9142
(407) 851-5121
(407) 851-0439
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
ME91130
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008500200
—
FL
Enumeration date
06/23/2006
Last updated
03/16/2021
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