Individual
MANEESHA TAILOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
841 E OAK ST, KISSIMMEE, FL 34744-5838
(407) 847-2050
(407) 847-9866
Mailing address
10140 CENTURION PKWY N, JACKSONVILLE, FL 32256-0532
(904) 697-4100
(904) 697-5102
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
126963
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017397000
—
FL
Enumeration date
05/15/2013
Last updated
05/28/2019
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