Provider Demographics
NPI:1740659440
Name:NANDAKUMAR, SREEJA
Entity type:Individual
Prefix:
First Name:SREEJA
Middle Name:
Last Name:NANDAKUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRIMARY CARE TRAINING CENTER, 25 SOUTH TERRY AVENUE
Mailing Address - Street 2:SUITE310
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805
Mailing Address - Country:US
Mailing Address - Phone:407-641-2444
Mailing Address - Fax:407-641-2445
Practice Address - Street 1:PRIMARY CARE TRAINING CENTER, 25 SOUTH TERRY AVENUE
Practice Address - Street 2:SUITE310
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-641-2444
Practice Address - Fax:407-641-2445
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9253181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily