Provider Demographics
NPI:1407956725
Name:NIBHANUPUDY, BOBBY (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:NIBHANUPUDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAKSHMI
Other - Middle Name:NARASIMHA
Other - Last Name:NIBHANUPUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2415 N ORANGE AVE SUITE 700
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-2474
Mailing Address - Fax:407-303-0680
Practice Address - Street 1:2415 N ORANGE AVE STE 700
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5521
Practice Address - Country:US
Practice Address - Phone:407-303-2474
Practice Address - Fax:407-303-0680
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84158208600000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18284Medicare UPIN