Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME111230 | FL |
NPI | 1023187960 |
---|---|
Provider Name | Dr. Lisa Nyanda-Manalo |
First Address | Maitland, FL 32751-7172 |
Second Address | Spring Hill, FL 34608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 27/07/2021 |