Healthcare Provider Details

I. General information

NPI: 1235338104
Provider Name (Legal Business Name): CHANDRA MALINI DONDAPATI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E KING ST
ORLANDO FL
32803-1205
US

IV. Provider business mailing address

PO BOX 940973
MAITLAND FL
32794-0973
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1558
  • Fax:
Mailing address:
  • Phone: 407-303-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberOS11553
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS11553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: