MEDICARE: FERNANDE NANDA MAMANE PHD

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	103TC0700X	Clinical Psychologist	PY12404	FL

General Provider Information

NPI Number	:	1134924566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDE NANDA MAMANE PHD

Provider Business Mailing Address
First Line	:	11011 SHERIDAN ST STE 211
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1531
Country	:	US
Telephone Number	:	954-408-2367
Fax Number	:

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST STE 211
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1531
Country	:	US
Telephone Number	:	954-408-2367
Fax Number	:

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

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	12/11/2025

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