Provider Demographics
NPI:1326063041
Name:RAJENDRAN, VIJAYALAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:RAJENDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SINGAMAREDDI
Other - Middle Name:
Other - Last Name:VIJAYALAKSHMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 LAKELAND HILLS BLVD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3257
Mailing Address - Country:US
Mailing Address - Phone:863-682-8200
Mailing Address - Fax:863-687-4161
Practice Address - Street 1:1500 LAKELAND HILLS BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3257
Practice Address - Country:US
Practice Address - Phone:863-682-8200
Practice Address - Fax:863-687-4161
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050181208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
13421501OtherCITRUS PROVIDER
I38984Medicare UPIN
07747AMedicare ID - Type Unspecified