Provider Demographics
NPI:1932143179
Name:KONDA, AMULYA (MD)
Entity Type:Individual
Prefix:
First Name:AMULYA
Middle Name:
Last Name:KONDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5314
Mailing Address - Country:US
Mailing Address - Phone:850-877-2105
Mailing Address - Fax:850-216-1321
Practice Address - Street 1:2400 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5314
Practice Address - Country:US
Practice Address - Phone:850-877-2105
Practice Address - Fax:850-216-1321
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079740207R00000X
FLME104404207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1460JOtherBCBS
FLCC843ZMedicare UPIN