South Lake Pediatrics, P.a.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME073750 Issued in FL

Legal business name

SOUTH LAKE PEDIATRICS, P.A.

Practice address

3155 Citrus Tower Blvd
BLDG.# 1
Clermont, FL 34711-6803

Phone

(352) 242-1500

Fax

(352) 242-0053

NPI assigned

Nov 3, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Adinarayanamurthy Nallamshetty, MDNPI 1538156609

Title

President

Phone

(352) 242-1500

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adinarayanamurthy Nallamshetty, M.D.

  • Pediatrics Physician
  • Clermont, FL
  • NPI 1538156609
  NPD (past) Authorized official

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

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1699076901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 CITRUS TOWER BLVD",
            "address_2": "BLDG.# 1",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347116803",
            "telephone_number": "352-242-1500",
            "fax_number": "352-242-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 CITRUS TOWER BLVD",
            "address_2": "BLDG.# 1",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347116803",
            "telephone_number": "352-242-1500",
            "fax_number": "352-242-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE PEDIATRICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-03",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "NALLAMSHETTY",
        "authorized_official_first_name": "ADINARAYANAMURTHY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-242-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME073750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260240700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Lake Internal Medicine PA
• South Lake Medical Center Inc
• South Lake Medicine P a
• South Lake Obstetrics & Gynecology, LLC
• South Lake Pain Institute, Inc
• South Lake Primary Care P a
• South Lake Wellness & Injury Center, PL
• Southlake Autism and Behavior Services, PA
• Sarah Michelle Spangler
• Yumika Sparkman, MSW, LCSW

• Pediatrics Physician in Clermont, FL
• Providers in Clermont, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; 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.