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General NPI Number Information
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NPI Number | 1740465707
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Entity Type | Individual
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Provider Name | AVINASH KRISHNA BHANDARY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 6909 OLD HIGHWAY 441 S SUITE 104
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City | MOUNT DORA
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State | FL
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Zip | 32757-7039
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Country | US
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Telephone | 407-605-5621
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 N DONNELLY ST STE 107
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City | MOUNT DORA
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State | FL
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Zip | 32757-2846
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Country | US
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Telephone | 407-605-5621
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Fax |
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME 114143
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License Number State | FL
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