Healthcare Provider Details

I. General information

NPI: 1730115007
Provider Name (Legal Business Name): MANISHI MUKHERJEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 49TH ST N SUITE 206N
ST PETERSBURG FL
33709-2150
US

IV. Provider business mailing address

5880 49TH ST N SUITE 206N
ST PETERSBURG FL
33709-2150
US

V. Phone/Fax

Practice location:
  • Phone: 727-526-9899
  • Fax: 727-526-6296
Mailing address:
  • Phone: 727-526-9899
  • Fax: 727-526-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0027749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: