Provider Demographics
NPI:1750811410
Name:MANMODE, SHEETAL RAHUL (DDS)
Entity type:Individual
Prefix:
First Name:SHEETAL
Middle Name:RAHUL
Last Name:MANMODE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHITAL
Other - Middle Name:VASANT
Other - Last Name:PATIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 W STATE ROAD 434 STE 1008
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4969
Mailing Address - Country:US
Mailing Address - Phone:407-830-4401
Mailing Address - Fax:
Practice Address - Street 1:1250 W STATE ROAD 434 STE 1008
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4969
Practice Address - Country:US
Practice Address - Phone:407-830-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857611122300000X
RIDEN03364122300000X
FLDN28518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist