MEDICARE: DR. BHARATHI EDDULA CHANGALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME131649	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME131649	FL

General Provider Information

NPI Number	:	1093112021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHARATHI EDDULA CHANGALA

Provider Business Mailing Address
First Line	:	434 W KENNEDY BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-6237
Country	:	US
Telephone Number	:	407-875-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	434 W KENNEDY BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-6237
Country	:	US
Telephone Number	:	407-875-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	07/21/2022

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