Provider Demographics
NPI:1093932576
Name:ANAMANDALA, SRILAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:SRILAKSHMI
Middle Name:
Last Name:ANAMANDALA
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:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:8620 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-3049
Practice Address - Country:US
Practice Address - Phone:941-966-4949
Practice Address - Fax:941-966-2489
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232144207Q00000X
FLME118389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14TQOtherBCBS
FL9452280OtherAETNA
FL010592800Medicaid
FL14TQOtherBCBS