MEDICARE: FNU MANISHA 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1467245308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FNU MANISHA M.D

Provider Business Mailing Address
First Line	:	4500 13TH STREET
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39501
Country	:	US
Telephone Number	:	228-822-6512
Fax Number	:	228-575-1937

Provider Business Practice Location Address
First Line	:	4500 13TH STREET
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39501
Country	:	US
Telephone Number	:	228-822-6512
Fax Number	:	228-575-1937

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

Provider Enumeration Date	:	05/23/2025
Last Update Date	:	03/03/2026

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Directions to “ FNU MANISHA M.D” Practice Location

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