Provider Demographics
NPI:1508119744
Name:RAY, PIYALI DAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PIYALI
Middle Name:DAS
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PIYALI
Other - Middle Name:DAS
Other - Last Name:SENGUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6535 NEMOURS PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7884
Mailing Address - Country:US
Mailing Address - Phone:361-549-4349
Mailing Address - Fax:
Practice Address - Street 1:1324 LAKELAND HILLS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4543
Practice Address - Country:US
Practice Address - Phone:361-549-4349
Practice Address - Fax:407-650-7256
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2022-10-31
Deactivation Date:2022-08-12
Deactivation Code:
Reactivation Date:2022-10-03
Provider Licenses
StateLicense IDTaxonomies
TXP3241208000000X, 2080P0206X
CAA1576142080P0206X
FLME1375772080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101176500Medicaid
TX310113102Medicaid
TX310113103OtherCSHCN