Healthcare Provider Details

I. General information

NPI: 1841216660
Provider Name (Legal Business Name): MANJIT JUNEJA VIRDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 GLENWOOD DR
WINTER PARK FL
32792-3314
US

IV. Provider business mailing address

2340 GLENWOOD DR
WINTER PARK FL
32792-3314
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0681
  • Fax: 407-975-0683
Mailing address:
  • Phone: 407-975-0681
  • Fax: 407-975-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME42002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: