| Radha Vallabhaneni Md Llc | |
|
3080 Nw 99th Ave Suite # 302 Coral Springs FL 33065-4038 | |
| (954) 796-9666 | |
| (954) 796-0333 |
| Full Name | Radha Vallabhaneni Md Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3080 Nw 99th Ave, Coral Springs, Florida |
| Authorized Official Name and Position | Radha Vallabhaneni (DOCTOR) |
| Authorized Official Contact | 9547969666 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radha Vallabhaneni Md Llc Po Box 970728 Coconut Creek FL 33097-0728 Ph: (954) 796-9666 | Radha Vallabhaneni Md Llc 3080 Nw 99th Ave Suite # 302 Coral Springs FL 33065-4038 Ph: (954) 796-9666 |
| NPI Number | 1275658528 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 09/01/2021 |
| Certification Date | 09/01/2021 |
| Medicare PECOS PAC ID | 7911068408 |
|---|---|
| Medicare Enrollment ID | O20081202000651 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275658528 | NPI | - | NPPES |
| 009430500 | Medicaid | FL | |
| 251368400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | ME81289 (Florida) | Primary |
| Provider Name | Radha Vallabhaneni |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649288374 PECOS PAC ID: 8123189610 Enrollment ID: I20081202000624 |
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