Provider Demographics
NPI:1851721666
Name:LUGO MANDES, NEJDA (MD)
Entity Type:Individual
Prefix:
First Name:NEJDA
Middle Name:
Last Name:LUGO MANDES
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 1:8000 RED BUG LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9265
Mailing Address - Country:US
Mailing Address - Phone:407-366-6004
Mailing Address - Fax:407-366-6603
Practice Address - Street 1:8000 RED BUG LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-366-6004
Practice Address - Fax:407-366-6603
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127038208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020509200Medicaid