Provider Demographics
NPI:1487321295
Name:BANDYOPADHYAY, ANASUA TORI (PA-C)
Entity type:Individual
Prefix:
First Name:ANASUA
Middle Name:TORI
Last Name:BANDYOPADHYAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 MIZELL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4155
Mailing Address - Country:US
Mailing Address - Phone:407-628-3073
Mailing Address - Fax:
Practice Address - Street 1:1925 MIZELL AVE STE 104
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4155
Practice Address - Country:US
Practice Address - Phone:407-628-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9120016363A00000X
OH50.007847RX363A00000X
OH50.007547RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical