MEDICARE: DR. MONIQUE LENORE MANGANELLI MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME111004	FL

General Provider Information

NPI Number	:	1659487536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIQUE LENORE MANGANELLI MD

Provider Business Mailing Address
First Line	:	4701 N FEDERAL HWY
Second Line	:	SUITE A-27
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4608
Country	:	US
Telephone Number	:	954-938-9966
Fax Number	:	954-938-8227

Provider Business Practice Location Address
First Line	:	4701 N FEDERAL HWY
Second Line	:	SUITE A-27
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4608
Country	:	US
Telephone Number	:	954-938-9966
Fax Number	:	954-938-8227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	06/24/2021

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