Provider Demographics
NPI:1962496059
Name:MANCHANDA, ROSY (MD)
Entity Type:Individual
Prefix:
First Name:ROSY
Middle Name:
Last Name:MANCHANDA
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 1:1082 E BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5509
Mailing Address - Country:US
Mailing Address - Phone:813-689-9900
Mailing Address - Fax:813-653-9696
Practice Address - Street 1:1082 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5509
Practice Address - Country:US
Practice Address - Phone:813-689-9900
Practice Address - Fax:813-653-9696
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82009OtherBCBS
FL268306700Medicaid
FL82009UMedicare PIN
FL268306700Medicaid