Provider Demographics
NPI:1326205923
Name:BHANUSALI, NEHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEHA
Middle Name:
Last Name:BHANUSALI
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 1:3400 QUADRANGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1492
Mailing Address - Country:US
Mailing Address - Phone:407-266-3627
Mailing Address - Fax:407-882-4799
Practice Address - Street 1:3400 QUADRANGLE BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1492
Practice Address - Country:US
Practice Address - Phone:407-266-3627
Practice Address - Fax:407-882-4799
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1111228207RR0500X, 207RR0500X
NY249695207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007280600Medicaid
TXTXB110489Medicare PIN