Healthcare Provider Details

I. General information

NPI: 1386045227
Provider Name (Legal Business Name): SOFIA MANTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DOUGLAS AVE STE 208
ALTAMONTE SPRINGS FL
32714-5206
US

IV. Provider business mailing address

231 HIGHLAND DR
DELTONA FL
32738-2267
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-6412
  • Fax: 407-830-7413
Mailing address:
  • Phone: 386-215-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: