Healthcare Provider Details

I. General information

NPI: 1801230644
Provider Name (Legal Business Name): MAUREEN MANSOUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 KING HELIE BLVD
NEW PORT RICHEY FL
34653-1435
US

IV. Provider business mailing address

21808 FL 54
LUTZ FL
33549
US

V. Phone/Fax

Practice location:
  • Phone: 866-762-1743
  • Fax: 727-816-1222
Mailing address:
  • Phone: 813-428-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME134792
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: