Provider Demographics
NPI:1134351067
Name:MADYAHNAPU, BHAVANA (MD)
Entity type:Individual
Prefix:DR
First Name:BHAVANA
Middle Name:
Last Name:MADYAHNAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 KERSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1936
Mailing Address - Country:US
Mailing Address - Phone:407-865-0968
Mailing Address - Fax:
Practice Address - Street 1:968 KERSFIELD CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1936
Practice Address - Country:US
Practice Address - Phone:407-865-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120379207Q00000X
FLME106299207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine