Provider Demographics
NPI:1104517242
Name:CHAMPANERIA, KRUPALI (PA)
Entity type:Individual
Prefix:
First Name:KRUPALI
Middle Name:
Last Name:CHAMPANERIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 N ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7049
Mailing Address - Country:US
Mailing Address - Phone:407-965-5109
Mailing Address - Fax:
Practice Address - Street 1:885 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7049
Practice Address - Country:US
Practice Address - Phone:407-965-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant