Provider Demographics
NPI:1265737126
Name:NAIR, NANDA K (DO)
Entity type:Individual
Prefix:DR
First Name:NANDA
Middle Name:K
Last Name:NAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:NANDA
Other - Middle Name:K
Other - Last Name:SOMARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 W BROADWAY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9262
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:218-421-9553
Practice Address - Street 1:1000 W BROADWAY ST STE 120
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9262
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:218-421-9553
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14748207RC0000X
NJ25MB08931200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021514400Medicaid