Organization
FLORIDAMEDCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANJULA NAYYAR M.D. (PHYSICIAN)
(772) 342-6911
Entity
Organization
Contact information
Practice address
1576 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5450
(772) 337-4578
Mailing address
1576 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5450
(772) 337-4578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME39359
FL
207RP1001X
Pulmonary Disease Physician
ME30367
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45124
BLUECROSS
FL
Enumeration date
03/28/2006
Last updated
10/27/2010
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