Healthcare Provider Details

I. General information

NPI: 1356363212
Provider Name (Legal Business Name): TREASURE COAST SLEEP DISORDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4750
US

IV. Provider business mailing address

PO BOX 187
JENSEN BEACH FL
34958-0187
US

V. Phone/Fax

Practice location:
  • Phone: 772-232-9990
  • Fax: 772-232-9989
Mailing address:
  • Phone: 772-232-9990
  • Fax: 772-232-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA MAMANGAKIS
Title or Position: MANAGER
Credential:
Phone: 772-232-9990