Healthcare Provider Details

I. General information

NPI: 1174842017
Provider Name (Legal Business Name): SUMALATHA NANDIKONDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 TAVISTOCK LAKES BLVD STE 160A
ORLANDO FL
32827-7665
US

IV. Provider business mailing address

720 W OAK ST STE 201
KISSIMMEE FL
34741-4998
US

V. Phone/Fax

Practice location:
  • Phone: 407-266-3627
  • Fax:
Mailing address:
  • Phone: 321-697-1734
  • Fax: 407-518-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT196363
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2013027012
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME172254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: