Healthcare Provider Details

I. General information

NPI: 1851286009
Provider Name (Legal Business Name): BRIDGECONNECT PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TAMPA ST STE 1550
TAMPA FL
33602-4737
US

IV. Provider business mailing address

400 N TAMPA ST STE 1550
TAMPA FL
33602-4737
US

V. Phone/Fax

Practice location:
  • Phone: 407-620-8775
  • Fax: 689-315-1283
Mailing address:
  • Phone: 407-620-8775
  • Fax: 689-315-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANITHA MOGALLAPU
Title or Position: OWNER
Credential: MD
Phone: 407-620-8775