Healthcare Provider Details

I. General information

NPI: 1922538883
Provider Name (Legal Business Name): MANISHA REENYE CHAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 MERIDIAN PKWY
WESTON FL
33331-3502
US

IV. Provider business mailing address

1919 SE 10TH AVE APT 6142
FORT LAUDERDALE FL
33316-3185
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5000
  • Fax:
Mailing address:
  • Phone: 914-233-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberME161966
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME161966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: