Individual
HIMABINDU GANDAM VENKATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.,
Contact information
Practice address
761 STIRLING CENTER PL, LAKE MARY, FL 32746
(386) 274-2977
(386) 274-2362
Mailing address
1671 N CLYDE MORRIS BLVD, STE 100, DAYTONA BEACH, FL 32117-5590
(386) 274-2977
(386) 274-2362
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME15113
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2015
Last updated
08/06/2021
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