Provider Demographics
NPI:1558356121
Name:MANDIA, STEPHEN ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ERNEST
Last Name:MANDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E ROLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1248
Mailing Address - Country:US
Mailing Address - Phone:407-897-3499
Mailing Address - Fax:407-896-9454
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-897-3499
Practice Address - Fax:407-896-9454
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE66696208800000X
VA0101056778208800000X
FLME0046763208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA76968864AMedicaid
CAFM0527638OtherDEA
GA76968864AMedicaid
FLP00758913Medicare PIN
FLAM3226087OtherDEA