Healthcare Provider Details

I. General information

NPI: 1528314093
Provider Name (Legal Business Name): NARENDRA DEREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 446
ORLANDO FL
32804-4644
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2528
  • Fax: 407-303-2760
Mailing address:
  • Phone: 407-303-2528
  • Fax: 407-303-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number48738
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME132276
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48738
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: