Basic Information
| Provider Information | |||||||||
| NPI: | 1477854057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLERGY AND ASTHMA CARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 S SHORE CREST DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336093625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133886855 | ||||||||
| FaxNumber: | 8133648107 | ||||||||
| Practice Location | |||||||||
| Address1: | 2407 CYPRESS RIDGE BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335446312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133886855 | ||||||||
| FaxNumber: | 8133648107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2010 | ||||||||
| LastUpdateDate: | 11/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | NALLAMSHETTY | ||||||||
| AuthorizedOfficialFirstName: | SAMRIDHI | ||||||||
| AuthorizedOfficialMiddleName: | NARULA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER AND PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 8133886855 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 000305500 | 05 | FL | MEDICAID |