Provider Demographics
NPI:1144273723
Name:CHERUKUPALLY, PALLAVI R (MD)
Entity type:Individual
Prefix:
First Name:PALLAVI
Middle Name:R
Last Name:CHERUKUPALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10920 MOSS PARK RD STE 218
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6087
Mailing Address - Country:US
Mailing Address - Phone:407-730-5600
Mailing Address - Fax:407-289-4036
Practice Address - Street 1:10920 MOSS PARK RD STE 218
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6087
Practice Address - Country:US
Practice Address - Phone:407-730-5600
Practice Address - Fax:407-289-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057788208100000X
FLME127634208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA319151189BMedicaid
GA319151189AMedicaid
GA319151189CMedicaid
GA319151189DMedicaid
GAH76402Medicare UPIN
GA319151189DMedicaid