Provider Demographics
NPI:1255728077
Name:BADHWAR, PRIYANKA (DO)
Entity type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:BADHWAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4098 LIBRA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-8026
Mailing Address - Country:US
Mailing Address - Phone:407-823-2701
Mailing Address - Fax:
Practice Address - Street 1:4098 LIBRA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-8026
Practice Address - Country:US
Practice Address - Phone:407-823-2701
Practice Address - Fax:407-823-0493
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS160152084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry