Healthcare Provider Details

I. General information

NPI: 1073117362
Provider Name (Legal Business Name): SANAYDADE MANNEUS QUIRION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2020
Last Update Date: 11/26/2020
Certification Date: 11/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SW WAYNE ST
PORT SAINT LUCIE FL
34984-4343
US

IV. Provider business mailing address

2120 SW WAYNE ST
PORT SAINT LUCIE FL
34984-4343
US

V. Phone/Fax

Practice location:
  • Phone: 561-685-4737
  • Fax:
Mailing address:
  • Phone: 561-685-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9531870
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9531870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: