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Individual

KENNETH MANDATO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
910 OLD CAMP RD STE 120, THE VILLAGES, FL 32162-5605
(352) 787-5858
(352) 728-6749
Mailing address
801 E DIXIE AVE STE 104, LEESBURG, FL 34748-7601
(352) 787-5858

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
ME136921
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME136921
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104390500
FL
Enumeration date
10/25/2006
Last updated
05/08/2020
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