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General NPI Number Information
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NPI Number | 1487520136
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Entity Type | Organization
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Legal Business Name | BOSTON REGENERATIVE MEDICINE LLC
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 1985 LONGWOOD LAKE MARY RD STE 1007
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City | LONGWOOD
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State | FL
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Zip | 32750-4674
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Country | US
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Telephone | 212-777-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 1985 LONGWOOD LAKE MARY RD STE 1007
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City | LONGWOOD
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State | FL
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Zip | 32750-4674
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Country | US
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Telephone | 212-777-0187
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Fax |
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Authorized Official
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Title or Position | MD & OWNER
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Name | VENKATA RAO EMANDI
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Credential |
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Telephone | 212-777-0187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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