Provider Demographics
NPI:1023187960
Name:NYANDA-MANALO, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:NYANDA-MANALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26809 TANIC DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-4605
Mailing Address - Country:US
Mailing Address - Phone:813-435-5199
Mailing Address - Fax:813-796-5389
Practice Address - Street 1:26809 TANIC DR STE 101
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-4605
Practice Address - Country:US
Practice Address - Phone:813-435-5199
Practice Address - Fax:813-796-5389
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111230207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology