Provider Demographics
NPI:1770443665
Name:BALASUBRAMANIAN, SAI CHARU BALA (MS)
Entity type:Individual
Prefix:
First Name:SAI CHARU BALA
Middle Name:
Last Name:BALASUBRAMANIAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 MOCCASIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5646
Mailing Address - Country:US
Mailing Address - Phone:917-594-2873
Mailing Address - Fax:
Practice Address - Street 1:1193 BLACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4518
Practice Address - Country:US
Practice Address - Phone:407-851-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH28602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty