Provider Demographics
NPI:1821019001
Name:JAIMANGAL, HEMWATTIE S (DO)
Entity type:Individual
Prefix:DR
First Name:HEMWATTIE
Middle Name:S
Last Name:JAIMANGAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18981 US HIGHWAY 441 STE 121
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6735
Mailing Address - Country:US
Mailing Address - Phone:352-633-9858
Mailing Address - Fax:352-633-9870
Practice Address - Street 1:8550 NE 138TH LN STE 500
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6804
Practice Address - Country:US
Practice Address - Phone:352-633-9858
Practice Address - Fax:352-633-9870
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10278207RI0200X
FLOS 102278207RI0200X
NY229853207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000337900Medicaid
FLAQ798ZMedicare PIN
AQ798YMedicare UPIN
FL000337900Medicaid