Provider Demographics
NPI:1720342173
Name:KISWANI-BARLEY, VANDHANA BHAGWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VANDHANA
Middle Name:BHAGWAN
Last Name:KISWANI-BARLEY
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 1:31055 JOSIE BILLIE HWY
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440
Mailing Address - Country:US
Mailing Address - Phone:863-983-5151
Mailing Address - Fax:863-983-7875
Practice Address - Street 1:31055 JOSIE BILLIE HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440
Practice Address - Country:US
Practice Address - Phone:863-983-5151
Practice Address - Fax:863-983-7875
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJE556ZOtherMEDICARE