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General NPI Number Information
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NPI Number | 1669467155
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Entity Type | Individual
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Provider Name | SRINIVAS RAO DONTINENI MD
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 2428 CLEARLAKE RD BLDG K
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City | COCOA
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State | FL
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Zip | 32922-5722
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Country | US
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Telephone | 321-368-3862
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Fax | 321-208-8717
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Provider Business Mailing Address
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Address Line | PO BOX 560059
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City | ROCKLEDGE
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State | FL
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Zip | 32956-0059
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Country | US
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Telephone | 321-795-6380
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Fax | 321-208-8515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ME88036
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License Number State | FL
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