Provider Demographics
NPI:1023198009
Name:NALLAPILLAI, ANANTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANTHY
Middle Name:
Last Name:NALLAPILLAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 CROWN POINT CT
Mailing Address - Street 2:STE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5967
Mailing Address - Country:US
Mailing Address - Phone:904-880-5220
Mailing Address - Fax:904-880-5227
Practice Address - Street 1:3661 CROWN POINT CT
Practice Address - Street 2:STE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5967
Practice Address - Country:US
Practice Address - Phone:904-880-5220
Practice Address - Fax:904-880-5227
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255543300Medicaid
FLG40471Medicare UPIN
FL255543300Medicaid