Provider Demographics
NPI:1689379877
Name:KONDA, PRIYA (FNP-C)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:KONDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 PRAVNY LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7092
Mailing Address - Country:US
Mailing Address - Phone:321-948-9888
Mailing Address - Fax:
Practice Address - Street 1:2278 PRAVNY LN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7092
Practice Address - Country:US
Practice Address - Phone:321-948-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025509363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner