Healthcare Provider Details

I. General information

NPI: 1255728077
Provider Name (Legal Business Name): PRIYANKA BADHWAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4098 LIBRA DR
ORLANDO FL
32816-8026
US

IV. Provider business mailing address

4098 LIBRA DR
ORLANDO FL
32816-8026
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-2701
  • Fax: 407-823-0493
Mailing address:
  • Phone: 407-823-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS16015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: