Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 250077 | NY |
Y | 2084N0402X | Child Neurologist | ME113018 | FL |
NPI | 1255581070 |
---|---|
Provider Name | Sagarika Nallu |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612-3803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016414800 | (05) | FL |
9XISC | BLUE CROSS BLUE SHIELD (01) | FL |