Individual provider Active NPI

Maneesha Tailor, M.D.

  • Pediatrics Physician
  • Kissimmee, FL
National Provider Identifier
1710323811
Registry record updated May 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
126963 Issued in FL
Practice address
841 E Oak St
Kissimmee, FL 34744-5838
Phone
(407) 847-2050
Fax
(407) 847-9866
NPI assigned
May 15, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 126963 FL Primary

Addresses

Primary practice location

841 E Oak St
Kissimmee, FL 34744-5838

Mailing address

10140 Centurion Pkwy N
Jacksonville, FL 32256-0532
Phone (904) 697-4100

Other identifiers 1

IdentifierTypeStateIssuer
017397000MedicaidFL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140121000861 FL Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 1153559125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
126963FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Health Alliance, LLC Pediatrics Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559001600000",
    "number": "1710323811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10140 CENTURION PKWY N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560532",
            "telephone_number": "904-697-4100",
            "fax_number": "904-697-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 E OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347445838",
            "telephone_number": "407-847-2050",
            "fax_number": "407-847-9866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAILOR",
        "first_name": "MANEESHA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-15",
        "last_updated": "2019-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "126963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017397000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.