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General NPI Number Information
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NPI Number | 1821019001
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Entity Type | Individual
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Provider Name | HEMWATTIE S JAIMANGAL DO
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Gender | Female
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 8550 NE 138TH LN STE 500
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City | LADY LAKE
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State | FL
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Zip | 32159-6804
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Country | US
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Telephone | 352-633-9858
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Fax | 352-633-9870
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Provider Business Mailing Address
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Address Line | 18981 US HIGHWAY 441 STE 121
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City | MOUNT DORA
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State | FL
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Zip | 32757-6735
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Country | US
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Telephone | 352-633-9858
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Fax | 352-633-9870
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | OS10278
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License Number State | FL
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