Provider Demographics
NPI:1336235720
Name:NAGABANDI, SRINIVAS RAO (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:RAO
Last Name:NAGABANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6719 GALL BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2571
Mailing Address - Country:US
Mailing Address - Phone:813-715-9100
Mailing Address - Fax:813-715-9144
Practice Address - Street 1:6719 GALL BLVD
Practice Address - Street 2:STE 204
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2571
Practice Address - Country:US
Practice Address - Phone:813-715-9100
Practice Address - Fax:813-715-9144
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 90157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16862ZMedicare ID - Type Unspecified