Provider Demographics
NPI:1568025088
Name:HARDEO, ANJALI ALYSSA (DO)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:ALYSSA
Last Name:HARDEO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W PINEVIEW ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2007
Mailing Address - Country:US
Mailing Address - Phone:407-862-3400
Mailing Address - Fax:
Practice Address - Street 1:125 W PINEVIEW ST STE 1001
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2007
Practice Address - Country:US
Practice Address - Phone:407-862-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS19588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program