Provider Demographics
NPI:1215795992
Name:BHOODAI, DENESH
Entity type:Individual
Prefix:
First Name:DENESH
Middle Name:
Last Name:BHOODAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 KURUME CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5670
Mailing Address - Country:US
Mailing Address - Phone:770-883-6327
Mailing Address - Fax:
Practice Address - Street 1:2627 W EAU GALLIE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8303
Practice Address - Country:US
Practice Address - Phone:321-837-3820
Practice Address - Fax:855-819-6516
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant