Healthcare Provider Details

I. General information

NPI: 1548211204
Provider Name (Legal Business Name): MAYUR MANIAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 N PINE ISLAND RD
SUNRISE FL
33351-6637
US

IV. Provider business mailing address

6245 N FEDERAL HWY 300
FT LAUDERDALE FL
33308-1998
US

V. Phone/Fax

Practice location:
  • Phone: 954-321-1776
  • Fax: 954-321-1878
Mailing address:
  • Phone: 954-956-1966
  • Fax: 954-745-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME0051260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: