Organization
PANDYA & NIME MD PA
Active
Other names
Pathology and Medical Laboratory Diagnostic Services
Organization subpart
No
Provider details
NPI number
Authorized official
SHONDELL BOUIE MD (PRESIDENT)
(321) 636-2211
Entity
Organization
Contact information
Practice address
110 LONGWOOD AVE, ROCKLEDGE, FL 32955-2828
(321) 636-2211
(321) 633-7085
Mailing address
PO BOX 1943, INDIANAPOLIS, IN 46206-1943
(877) 261-9061
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055386700
—
FL
05
—
055386703
—
FL
Enumeration date
02/24/2006
Last updated
02/08/2022
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