Provider Demographics
NPI:1194761171
Name:MANDALIYA, NAISHADH K (MD)
Entity type:Individual
Prefix:DR
First Name:NAISHADH
Middle Name:K
Last Name:MANDALIYA
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 1:2810 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1853
Mailing Address - Country:US
Mailing Address - Phone:813-935-5501
Mailing Address - Fax:813-933-8784
Practice Address - Street 1:2810 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1853
Practice Address - Country:US
Practice Address - Phone:813-935-5501
Practice Address - Fax:813-933-8784
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057305174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063578200Medicaid
FL10368OtherBCBS
FL290002966OtherRR MEDICARE
FL210685OtherAVMED
FL00164OtherWELLCARE
FL210685OtherAVMED
FL063578200Medicaid