Healthcare Provider Details

I. General information

NPI: 1144273723
Provider Name (Legal Business Name): PALLAVI R. CHERUKUPALLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 MOSS PARK RD STE 218
ORLANDO FL
32832-6087
US

IV. Provider business mailing address

10920 MOSS PARK RD STE 218
ORLANDO FL
32832-6087
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-5600
  • Fax: 407-289-4036
Mailing address:
  • Phone: 407-730-5600
  • Fax: 407-289-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number057788
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME127634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: