Provider Demographics
NPI:1437542750
Name:CHELLU, SANTI REKHA (FNP)
Entity Type:Individual
Prefix:
First Name:SANTI
Middle Name:REKHA
Last Name:CHELLU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 LAKEVIEW DR # 1001
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2009
Mailing Address - Country:US
Mailing Address - Phone:407-900-0613
Mailing Address - Fax:321-407-6945
Practice Address - Street 1:2915 LAKEVIEW DR # 1001
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2009
Practice Address - Country:US
Practice Address - Phone:407-900-0613
Practice Address - Fax:407-335-6945
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9368774363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9368774OtherMEDICAL LICENSE
FL017298700Medicaid
FLARNP9368774OtherMEDICAL LICENSE