MEDICARE: SRINIVAS RAO NAGABANDI MD

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	207Q00000X	Family Medicine Physician	ME 90157	FL

General Provider Information

NPI Number	:	1336235720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRINIVAS RAO NAGABANDI MD

Provider Business Mailing Address
First Line	:	6719 GALL BLVD
Second Line	:	STE 204
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2571
Country	:	US
Telephone Number	:	813-715-9100
Fax Number	:	813-715-9144

Provider Business Practice Location Address
First Line	:	6719 GALL BLVD
Second Line	:	STE 204
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2571
Country	:	US
Telephone Number	:	813-715-9100
Fax Number	:	813-715-9144

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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