Healthcare Provider Details

I. General information

NPI: 1134924566
Provider Name (Legal Business Name): FERNANDE NANDA MAMANE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 211
HOLLYWOOD FL
33026-1531
US

IV. Provider business mailing address

11011 SHERIDAN ST STE 211
HOLLYWOOD FL
33026-1531
US

V. Phone/Fax

Practice location:
  • Phone: 954-408-2367
  • Fax:
Mailing address:
  • Phone: 954-408-2367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: