Healthcare Provider Details

I. General information

NPI: 1679312938
Provider Name (Legal Business Name): OVIEDO CHILDRENS HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15528 W COLONIAL DR STE B
WINTER GARDEN FL
34787-9556
US

IV. Provider business mailing address

15528 W COLONIAL DR STE B
WINTER GARDEN FL
34787-9556
US

V. Phone/Fax

Practice location:
  • Phone: 407-977-1135
  • Fax:
Mailing address:
  • Phone: 407-977-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SADIQ MANDANI
Title or Position: OWNER
Credential: MD
Phone: 407-977-1135