Healthcare Provider Details

I. General information

NPI: 1750848727
Provider Name (Legal Business Name): VARENDRA JAMWANT DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N US HWY 441 STE 201
LADY LAKE FL
32159-3002
US

IV. Provider business mailing address

PO BOX 771004
WINTER GARDEN FL
34777-1004
US

V. Phone/Fax

Practice location:
  • Phone: 407-923-5268
  • Fax:
Mailing address:
  • Phone: 407-900-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VARENDRA JAMWANT
Title or Position: CEO
Credential: DPM
Phone: 352-259-2159