Basic Information
| Provider Information | |||||||||
| NPI: | 1700997707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAREWAL | ||||||||
| FirstName: | MANDEEP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 CLYDE MORRIS BLVD STE 390 | ||||||||
| Address2: | |||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321748179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866766335 | ||||||||
| FaxNumber: | 3862567629 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 MIRROR LAKE DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866732500 | ||||||||
| FaxNumber: | 3866733204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 2005027549 | MO | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084D0003X | ME095705 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Diagnostic Neuroimaging |
ID Information
| ID | Type | State | Issuer | Description | 278731800 | 05 | FL | MEDICAID | ME0095705 | 01 | FL | LICENSE | OTHER |