Healthcare Provider Details

I. General information

NPI: 1588488944
Provider Name (Legal Business Name): SIRENISEA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1696 SE HILLMOOR DR STE C
PORT SAINT LUCIE FL
34952-7699
US

IV. Provider business mailing address

1696 SE HILLMOOR DR STE C
PORT SAINT LUCIE FL
34952-7699
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-3222
  • Fax: 772-335-3793
Mailing address:
  • Phone: 772-335-3222
  • Fax: 772-335-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEAGHAN CROSBY
Title or Position: OWNER
Credential:
Phone: 772-335-3222