Provider Demographics
NPI:1528172731
Name:ORLANDO PSYCHIATRIC ASSOCIATES INC.
Entity type:Organization
Organization Name:ORLANDO PSYCHIATRIC ASSOCIATES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHASKAR
Authorized Official - Middle Name:NANDIMANDALAM
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-851-5121
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-0714
Mailing Address - Country:US
Mailing Address - Phone:407-851-5121
Mailing Address - Fax:407-851-0439
Practice Address - Street 1:2345 SAND LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-9142
Practice Address - Country:US
Practice Address - Phone:407-851-5121
Practice Address - Fax:407-851-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME911302084P0804X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009616900Medicaid