Provider Demographics
NPI:1891920492
Name:KHAKU, AUNALI S (MD)
Entity Type:Individual
Prefix:DR
First Name:AUNALI
Middle Name:S
Last Name:KHAKU
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 1:473 MOHAVE TER
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-7017
Mailing Address - Country:US
Mailing Address - Phone:786-245-3110
Mailing Address - Fax:407-345-9765
Practice Address - Street 1:473 MOHAVE TER
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7017
Practice Address - Country:US
Practice Address - Phone:786-245-3110
Practice Address - Fax:888-613-6275
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1146112084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104800500Medicaid
FL14Z2ZOtherBCBS FL