Rekha Nidadavolu, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111839 Issued in FL

Practice address

4745 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400

Phone

(305) 905-9316

NPI assigned

Feb 11, 2010

Last updated

Jan 30, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Dr. Rekha Pinjala Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake City Institute of Neurology PA

  dba Florida Institute of Neurology

  • Neuromuscular Medicine (Psychiatry & Neurology) Physician
  • Saint Cloud, FL
  • NPI 1578922613
  Authorized official Same address or phone
• Lake City Institute of Neurology PA

  dba Florida Institute of Neurology

  • Neurology Physician
  • Saint Cloud, FL
  • NPI 1710266895
  Authorized official Same address or phone
• Grey Dog Inc

  dba Baptist Medical Arts Pharmacy

  • Community/Retail Pharmacy
  • Miami, FL
  • NPI 1568546901
  NPD (past)

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

{
    "created_epoch": "1265846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1902138217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400",
            "telephone_number": "305-905-9316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400",
            "telephone_number": "305-905-9316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIDADAVOLU",
        "first_name": "REKHA",
        "name_prefix": "Ms.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-11",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111839",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS44664",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "24667",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "24667",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA PHYSICIAN ASSISTANT BOARD",
            "identifier": "PA9111839",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BOARD OF PHARMACY",
            "identifier": "PS44664",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REKHA",
            "last_name": "PINJALA",
            "prefix": "DR.",
            "credential": "PHARM-D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Phuong Q Nguyen, PHARMD
• Rachel Nguyen
• Carmelita Ocampo Nicdao, MD
• Nico Care Services LLC
• Naga Lakshmana Prasad Nidadavolu, M.D
• Edward Troy Nielsen, L.M.H.C.
• Glenda Marie Nieves Perez, M.D.
• Ivelisse Nieves, LMHC
• Jeisse Nodar, RBT
• Robert Noll, M.S.

• Physician Assistant in Saint Cloud, FL
• Providers in Saint Cloud, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.