Provider Demographics
NPI:1134924566
Name:MAMANE, FERNANDE NANDA (PHD)
Entity type:Individual
Prefix:
First Name:FERNANDE
Middle Name:NANDA
Last Name:MAMANE
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 E SANDPIPER CIR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2809
Mailing Address - Country:US
Mailing Address - Phone:786-991-7529
Mailing Address - Fax:
Practice Address - Street 1:1431 E SANDPIPER CIR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2809
Practice Address - Country:US
Practice Address - Phone:786-991-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12404103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical