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General NPI Number Information
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NPI Number | 1730375460
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Entity Type | Individual
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Provider Name | SHIRISHA RAO VALLARAPU PAC
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Gender | Female
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 13681 METROPOLIS AVE
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City | FORT MYERS
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State | FL
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Zip | 33912-4318
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Country | US
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Telephone | 800-400-3376
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Fax | 239-561-3020
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Provider Business Mailing Address
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Address Line | 151 SOUTHHALL LN STE 300
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City | MAITLAND
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State | FL
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Zip | 32751-7172
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Country | US
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Telephone | 800-400-3376
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Fax | 407-650-3455
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9111573
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License Number State | FL
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