Provider Demographics
NPI:1225133911
Name:YADLAPALLI, BRAHMANANDA RAO (MD)
Entity Type:Individual
Prefix:
First Name:BRAHMANANDA
Middle Name:RAO
Last Name:YADLAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 PALM COAST PKWY NE STE 4
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3889
Mailing Address - Country:US
Mailing Address - Phone:386-445-7073
Mailing Address - Fax:386-246-3839
Practice Address - Street 1:315 PALM COAST PKWY NE STE 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3889
Practice Address - Country:US
Practice Address - Phone:386-445-7073
Practice Address - Fax:386-246-3839
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1624542084N0400X
FLME1243662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108019200Medicaid
A61115Medicare UPIN