Provider Demographics
NPI:1538195656
Name:MONDAL, SAMBIT (MD)
Entity type:Individual
Prefix:DR
First Name:SAMBIT
Middle Name:
Last Name:MONDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 MAITLAND AVE
Mailing Address - Street 2:STE 116
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4913
Mailing Address - Country:US
Mailing Address - Phone:407-915-5643
Mailing Address - Fax:407-960-2602
Practice Address - Street 1:251 MAITLAND AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4914
Practice Address - Country:US
Practice Address - Phone:407-915-5643
Practice Address - Fax:407-960-2602
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95035207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01026580OtherMEDICARE RAILROAD
FL003204200Medicaid
FLEM089YMedicare PIN
FLP01026580OtherMEDICARE RAILROAD