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General NPI Number Information
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NPI Number | 1427383512
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Entity Type | Organization
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Legal Business Name | MALLIKARJUNA NANDYALA MD PA
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 8313 W HILLSBOROUGH AVE STE 300
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City | TAMPA
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State | FL
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Zip | 33615-3819
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Country | US
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Telephone | 813-884-0222
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Fax | 813-884-0080
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Provider Business Mailing Address
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Address Line | 14749 WATERCHASE BLVD
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City | TAMPA
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State | FL
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Zip | 33626-3318
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Country | US
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Telephone | 813-884-0222
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Fax | 813-884-0080
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALLIKARJUNA NANDYALA
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Credential | M.D.
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Telephone | 813-884-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0070271
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License Number State | FL
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