MEDICARE: DR. AVINASH KRISHNA BHANDARY M.D.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	ME 114143	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14ME6	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1740465707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVINASH KRISHNA BHANDARY M.D.

Provider Business Mailing Address
First Line	:	1502 N DONNELLY ST
Second Line	:	STE 107
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2846
Country	:	US
Telephone Number	:	407-605-5621
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 OLD HIGHWAY 441 S
Second Line	:	SUITE 104
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7039
Country	:	US
Telephone Number	:	407-605-5621
Fax Number	:

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

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	02/09/2018

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