Healthcare Provider Details

I. General information

NPI: 1922067834
Provider Name (Legal Business Name): ANUPAMA UPADYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 HIGHWAY 466
LADY LAKE FL
32159-6340
US

IV. Provider business mailing address

753 HIGHWAY 466
LADY LAKE FL
32159-6340
US

V. Phone/Fax

Practice location:
  • Phone: 352-391-5500
  • Fax: 352-391-5501
Mailing address:
  • Phone: 352-391-5500
  • Fax: 352-391-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number039405
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number039405
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number97830
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number97830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: