MEDICARE: DR. FANYA KANDINOV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA07115100	NJ
2	207R00000X	Internal Medicine Physician	ME119379	FL

General Provider Information

NPI Number	:	1811943277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FANYA KANDINOV MD

Provider Business Mailing Address
First Line	:	301 174TH ST
Second Line	:	APT 1918
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-3206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 174TH ST
Second Line	:	APT 1918
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-3206
Country	:	US
Telephone Number	:	201-328-2888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/02/2015

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