Buddha P.a

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BUDDHA P.A

Doing business as

Malabar Family Practice

Practice address

1731 Banaghen Dr
Melbourne, FL 32940-6012

Phone

(614) 404-0972

NPI assigned

May 12, 2020

Last updated

Jul 9, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chaithanya Deepthi Buddha, MD

Title

President

Phone

(614) 404-0972

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Malabar Family Practice Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1144842246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 BANAGHEN DR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329406012",
            "telephone_number": "614-404-0972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 BANAGHEN DR",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329406012",
            "telephone_number": "614-404-0972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUDDHA P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "BUDDHA",
        "authorized_official_first_name": "CHAITHANYA DEEPTHI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-404-0972",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE CROSS BLUE SHIELD",
            "identifier": "14Y3K",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malabar Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Malabar Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bsa LLC (Brevard Surgical Associates TEPAS Healthcare)
• Asia Buchanan
• Jalynn Buchanan
• Jerod Thomas Buchta
• Sara J Buckley, PSY.D.
• Chaithanya Deepthi Buddha, M.D.
• Elise Budesheim
• Angela Bueno, PT
• Patricia A Buescher, APRN
• Building Bridges LLC

• Primary Care Clinic/Center in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.