Organization
LAKE CITY INSTITUTE OF NEUROLOGY PA
Active
Other names
Florida Institute of Neurology
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REKHA NIDADAVOLU (MANAGER)
(305) 905-9316
Entity
Organization
Contact information
Practice address
4745 OLD CANOE CREEK RD, SAINT CLOUD, FL 34769-1400
(407) 818-1664
(407) 818-1654
Mailing address
4745 OLD CANOE CREEK RD, SAINT CLOUD, FL 34769-1400
(407) 818-1664
(407) 818-1654
Taxonomy
Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003957500
—
FL
01
—
14H5X
BCBS
FL
01
—
DS6851
RAILROAD MEDICARE
FL
Enumeration date
02/17/2016
Last updated
01/09/2025
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