Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY9152 | FL |
NPI | 1013661503 |
---|---|
Provider Name | Dr. Nadya Lynn Kamla Tilluckdharry |
First Address | Winter Springs, FL 32708-5037 |
Second Address | Winter Springs, FL 32708-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2022 |
Last Update Date | 04/02/2022 |