Provider Demographics
NPI:1740592377
Name:DEVYANI BELSARE MD LLC
Entity Type:Organization
Organization Name:DEVYANI BELSARE MD LLC
Other - Org Name:ORANGE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEVYANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BELSARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-557-2165
Mailing Address - Street 1:251 MAITLAND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4913
Mailing Address - Country:US
Mailing Address - Phone:407-557-2165
Mailing Address - Fax:407-369-4612
Practice Address - Street 1:251 MAITLAND AVE STE 104
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4913
Practice Address - Country:US
Practice Address - Phone:407-557-2165
Practice Address - Fax:407-369-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100607208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000602500Medicaid