MEDICARE: TREASURE COAST SLEEP DISORDERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356363212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE COAST SLEEP DISORDERS LLC

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34958-0187
Country	:	US
Telephone Number	:	772-232-9990
Fax Number	:	772-232-9989

Provider Business Practice Location Address
First Line	:	642 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4750
Country	:	US
Telephone Number	:	772-232-9990
Fax Number	:	772-232-9989

Authorized Official
Title or Position	:	MANAGER
Name	:	MARIA MAMANGAKIS
Credential	:
Telephone Number	:	772-232-9990

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	05/01/2025

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