Provider Demographics
NPI:1952393803
Name:VISHNUBHOTLA, PRIYA SHIVA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:SHIVA
Last Name:VISHNUBHOTLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:70 W GORE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-426-8484
Mailing Address - Fax:407-426-8575
Practice Address - Street 1:70 W GORE ST
Practice Address - Street 2:STE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1124
Practice Address - Country:US
Practice Address - Phone:407-426-8484
Practice Address - Fax:407-426-8575
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME93654207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology