Organization
SOUTH LAKE PEDIATRICS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADINARAYANAMURTHY NALLAMSHETTY MD (PRESIDENT)
(352) 242-1500
Entity
Organization
Contact information
Practice address
3155 CITRUS TOWER BLVD, BLDG.# 1, CLERMONT, FL 34711-6803
(352) 242-1500
(352) 242-0053
Mailing address
3155 CITRUS TOWER BLVD, BLDG.# 1, CLERMONT, FL 34711-6803
(352) 242-1500
(352) 242-0053
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME073750
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260240700
—
FL
Enumeration date
11/03/2010
Last updated
11/03/2010
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