Provider Demographics
NPI:1396774469
Name:RAO, VANDANA BALAKRISHNA (DO)
Entity type:Individual
Prefix:DR
First Name:VANDANA
Middle Name:BALAKRISHNA
Last Name:RAO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 CYPRESS TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8561
Mailing Address - Country:US
Mailing Address - Phone:321-235-9127
Mailing Address - Fax:
Practice Address - Street 1:855 SOUTH U.S. HIGHWAY 17-92
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750
Practice Address - Country:US
Practice Address - Phone:407-699-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0866ZMedicare ID - Type Unspecified
FLH87006Medicare UPIN