Provider Demographics
NPI:1558397620
Name:RAJU, BHASKAR NANDIMANDALAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BHASKAR
Middle Name:NANDIMANDALAM
Last Name:RAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 SAND LAKE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-9142
Mailing Address - Country:US
Mailing Address - Phone:407-851-5121
Mailing Address - Fax:407-851-0439
Practice Address - Street 1:2345 SAND LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-9142
Practice Address - Country:US
Practice Address - Phone:407-851-5121
Practice Address - Fax:407-851-0439
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME911302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008500200Medicaid
FL03443ZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
FL008500200Medicaid
FL127289Medicare UPIN