Provider Demographics
NPI:1437410230
Name:COODUVALLI, BETSY (DO)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:COODUVALLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:LEVERITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 690609
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-0609
Mailing Address - Country:US
Mailing Address - Phone:407-846-7546
Mailing Address - Fax:321-206-5419
Practice Address - Street 1:500 N WASHINGTON AVE STE 109
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-768-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10726207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4583149OtherCIGNA
FL14M7EOtherBCBS
FL4583149OtherCIGNA