Provider Demographics
NPI:1619955671
Name:MANI, NISHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:S
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11398
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1398
Mailing Address - Country:US
Mailing Address - Phone:877-448-8675
Mailing Address - Fax:772-621-3180
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-267-6650
Practice Address - Fax:954-351-7874
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL919772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271690900Medicaid
FLU4245AMedicare PIN
FL271690900Medicaid
FLU4245BMedicare PIN