Healthcare Provider Details

I. General information

NPI: 1720391857
Provider Name (Legal Business Name): DHARSHINI YOGENDRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 LAKE UNDERHILL ROAD
ORLANDO FL
32807
US

IV. Provider business mailing address

2400 STATE ROAD 415
SANFORD FL
32771-6012
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-8645
  • Fax: 407-330-5074
Mailing address:
  • Phone: 407-322-8645
  • Fax: 407-330-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: