Healthcare Provider Details

I. General information

NPI: 1871734749
Provider Name (Legal Business Name): CHRISTY LYNN MANGANELLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LAKE ELLENOR DR
ORLANDO FL
32809-4618
US

IV. Provider business mailing address

5900 LAKE ELLENOR DR
ORLANDO FL
32809-4618
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-2542
  • Fax: 407-352-2547
Mailing address:
  • Phone: 407-352-2542
  • Fax: 407-352-2547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME122033
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME122033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: