Individual
LENKALA R MALLAIAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
311 N MANGOUSTINE AVE, SANFORD, FL 32771-1098
(407) 321-4570
(407) 321-7690
Mailing address
311 N MANGOUSTINE AVE, SANFORD, FL 32771-1098
(407) 321-4570
(407) 321-7690
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME0037029
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065414100
—
FL
01
—
59292
BS/BS
FL
Enumeration date
07/20/2005
Last updated
03/01/2012
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