Healthcare Provider Details

I. General information

NPI: 1891679486
Provider Name (Legal Business Name): RADIANT RHEUMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 HARTWOOD MARSH RD STE 3
CLERMONT FL
34711-5390
US

IV. Provider business mailing address

11538 DELWICK DR
WINDERMERE FL
34786-6073
US

V. Phone/Fax

Practice location:
  • Phone: 347-216-5347
  • Fax:
Mailing address:
  • Phone: 347-216-5347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHUBHA KOLLAMPARE
Title or Position: OWNER
Credential: MD
Phone: 352-810-9073