Provider Demographics
NPI:1730375460
Name:VALLARAPU, SHIRISHA RAO (PAC)
Entity type:Individual
Prefix:MRS
First Name:SHIRISHA
Middle Name:RAO
Last Name:VALLARAPU
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Gender:
Credentials:PAC
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Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:800-400-3376
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:13681 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4318
Practice Address - Country:US
Practice Address - Phone:800-400-3376
Practice Address - Fax:239-561-3020
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2025-03-26
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant