Provider Demographics
NPI:1336165760
Name:MANDANI, SADIQ (MD)
Entity Type:Individual
Prefix:
First Name:SADIQ
Middle Name:
Last Name:MANDANI
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 1:870 CLARK ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9270
Mailing Address - Country:US
Mailing Address - Phone:407-977-1135
Mailing Address - Fax:407-977-9946
Practice Address - Street 1:870 CLARK ST STE 1000
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9270
Practice Address - Country:US
Practice Address - Phone:407-977-1113
Practice Address - Fax:407-977-9946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 90618208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271972000Medicaid
FL271972000Medicaid
FL64124ZMedicare ID - Type Unspecified