Provider Demographics
NPI:1447700398
Name:KOLAVENTY, KAMESHWARI
Entity type:Individual
Prefix:MRS
First Name:KAMESHWARI
Middle Name:
Last Name:KOLAVENTY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KAMESHWARI
Other - Middle Name:
Other - Last Name:KOLAVENTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6600 SW HYW 200 STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-5554
Mailing Address - Country:US
Mailing Address - Phone:352-237-4116
Mailing Address - Fax:352-237-1785
Practice Address - Street 1:6600 SW HYW 200 STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-5554
Practice Address - Country:US
Practice Address - Phone:352-237-4116
Practice Address - Fax:352-237-1785
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program