Healthcare Provider Details

I. General information

NPI: 1295537934
Provider Name (Legal Business Name): KOPILA SANGROULA PANDEY AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOPILA SANGROULA APRN

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 LAKE UNDERHILL RD STE A
ORLANDO FL
32828-4507
US

IV. Provider business mailing address

1002 BELVOIR DR
KISSIMMEE FL
34744-8555
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-8700
  • Fax: 407-380-7043
Mailing address:
  • Phone: 571-533-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP11040021
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0001261399
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: