Healthcare Provider Details

I. General information

NPI: 1730797101
Provider Name (Legal Business Name): SPANDANA ALLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 N PARK RD
PLANT CITY FL
33563-2026
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD
LAKELAND FL
33813-1639
US

V. Phone/Fax

Practice location:
  • Phone: 813-757-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME169834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: