Healthcare Provider Details

I. General information

NPI: 1841384005
Provider Name (Legal Business Name): INFECTIOUS DISEASES ASSOCIATES OF NORTH FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL SUITE 205
ST AUGUSTINE FL
32086-5774
US

IV. Provider business mailing address

1093 A1A BEACH BLVD PMB 415
ST AUGUSTINE FL
32080-6733
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-9925
  • Fax: 904-819-9926
Mailing address:
  • Phone: 904-819-9925
  • Fax: 904-819-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME80064
License Number StateFL

VIII. Authorized Official

Name: MONALI MANIKAL
Title or Position: MANAGER
Credential: M.D.
Phone: 904-819-9925