Provider Demographics
NPI:1376258293
Name:NANDA, MANSI
Entity Type:Individual
Prefix:
First Name:MANSI
Middle Name:
Last Name:NANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9790 TAYLOR ROSE LN
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-2288
Mailing Address - Country:US
Mailing Address - Phone:727-256-5588
Mailing Address - Fax:
Practice Address - Street 1:9790 TAYLOR ROSE LN
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-2288
Practice Address - Country:US
Practice Address - Phone:727-256-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist