Provider Demographics
NPI:1700997707
Name:GAREWAL, MANDEEP (MD)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:GAREWAL
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 1:325 CLYDE MORRIS BLVD STE 390
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8179
Mailing Address - Country:US
Mailing Address - Phone:386-676-6335
Mailing Address - Fax:386-256-7629
Practice Address - Street 1:8 MIRROR LAKE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-673-2500
Practice Address - Fax:386-673-3204
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050275492084N0400X
FLME0957052084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278731800Medicaid
FLME0095705OtherLICENSE
FL278731800Medicaid