MEDICARE: KOPILA SANGROULA PANDEY AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	ARNP11040021	FL
2	363LA2100X	Acute Care Nurse Practitioner	0001261399	VA

General Provider Information

NPI Number	:	1295537934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOPILA SANGROULA PANDEY AGACNP-BC

Provider Business Mailing Address
First Line	:	1002 BELVOIR DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-8555
Country	:	US
Telephone Number	:	571-533-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	12315 LAKE UNDERHILL RD STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4507
Country	:	US
Telephone Number	:	407-380-8700
Fax Number	:	407-380-7043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	12/11/2025

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