Healthcare Provider Details

I. General information

NPI: 1225374085
Provider Name (Legal Business Name): PRIYA PRAKASH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 11/14/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 S US HWY 27
CLERMONT FL
34711-6699
US

IV. Provider business mailing address

2611 S US HWY 27
CLERMONT FL
34711-6699
US

V. Phone/Fax

Practice location:
  • Phone: 352-717-0603
  • Fax: 352-717-0604
Mailing address:
  • Phone: 352-717-0603
  • Fax: 352-717-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number32647
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME144273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: