Provider Demographics
NPI:1295537934
Name:SANGROULA PANDEY, KOPILA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:KOPILA
Middle Name:
Last Name:SANGROULA PANDEY
Suffix:
Gender:
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:KOPILA
Other - Middle Name:
Other - Last Name:SANGROULA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1002 BELVOIR DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8555
Mailing Address - Country:US
Mailing Address - Phone:571-533-5333
Mailing Address - Fax:
Practice Address - Street 1:11601 S ORANGE BLOSSOM TRL STE 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9437
Practice Address - Country:US
Practice Address - Phone:571-837-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001261399363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care