Healthcare Provider Details

I. General information

NPI: 1528298247
Provider Name (Legal Business Name): JAYAPRAKASH MANDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

IV. Provider business mailing address

1900 DON WICKHAM DR
CLERMONT FL
34711-1979
US

V. Phone/Fax

Practice location:
  • Phone: 352-536-8840
  • Fax: 352-536-8841
Mailing address:
  • Phone: 352-536-8840
  • Fax: 352-536-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA09277900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME162658
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA09277900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: