Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME96607 | FL |
NPI | 1346392362 |
---|---|
Provider Name | Vasudeva R Nalipireddy |
First Address | Melbourne, FL 32935-6857 |
Second Address | Melbourne, FL 32935-6857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 21/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
277542500 | (05) | FL |
375952 | WELLCARE (01) | FL |
7729582 | AETNA (01) | FL |
92262 | BLUE CROSS BLUE SHIELD (01) | FL |