Provider Demographics
NPI:1184808388
Name:BRINDALA, JAYARAM SRINIVASAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAYARAM
Middle Name:SRINIVASAN
Last Name:BRINDALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAYARAM
Other - Middle Name:
Other - Last Name:SRINIVASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:755 RINEHART RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4886
Mailing Address - Country:US
Mailing Address - Phone:407-320-8100
Mailing Address - Fax:407-320-8110
Practice Address - Street 1:755 RINEHART RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4886
Practice Address - Country:US
Practice Address - Phone:407-320-8100
Practice Address - Fax:407-320-8110
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4518882083P0901X
CAA1014212083P0901X
NY2689522083P0901X
FLME1426292083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine