MEDICARE: MANDANA DAVANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	321768	NY
2	2085R0202X	Diagnostic Radiology Physician	ME77783	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300121884	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003883885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDANA DAVANI M.D.

Provider Business Mailing Address
First Line	:	400 HEALTH PARK BLVD
Second Line	:	ATTN: RADIOLOGY DEPARTMENT
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5784
Country	:	US
Telephone Number	:	904-819-4398
Fax Number	:	904-819-4976

Provider Business Practice Location Address
First Line	:	400 HEALTH PARK BLVD
Second Line	:	ATTN: RADIOLOGY DEPARTMENT
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5784
Country	:	US
Telephone Number	:	904-819-4398
Fax Number	:	904-819-4976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	05/26/2026

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Directions to “ MANDANA DAVANI M.D.” Practice Location

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