Chandra Mangra, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME130034 Issued in FL

Practice address

17 Silver Palm Ave
Melbourne, FL 32901-3123

Phone

(321) 733-2021

Fax

(321) 727-0884

NPI assigned

May 19, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Chandra Jaipal Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Faith Family Health Care Professional Corp.

  • Health Service Clinic/Center
  • North Plainfield, NJ
  • NPI 1093041030
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1336306240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "321-952-9696",
            "fax_number": "321-952-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 SILVER PALM AVE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013123",
            "telephone_number": "321-733-2021",
            "fax_number": "321-727-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGRA",
        "first_name": "CHANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME130034",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "DEA 939",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019184300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHANDRA",
            "last_name": "JAIPAL",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gabriele Elisabeth Mamone, M.ED, ED.S.
• Joseph Robert Manarino
• Mancala Holdings, LLC (Mancala NEMT)
• Sharon Ann Mandaville, BS
• Michael N Mandese, O.D.
• Laura Manilli
• Debra B Mann, PTA
• Nancy A Mann, CRNA
• Shivani Sikiu Prashad Mann, DMD
• Tara Mann

• Family Medicine Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.