Healthcare Provider Details

I. General information

NPI: 1275314742
Provider Name (Legal Business Name): IMANYCO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5769 COCONUT BLVD
WEST PALM BEACH FL
33411-8545
US

IV. Provider business mailing address

5769 COCONUT BLVD
WEST PALM BEACH FL
33411-8545
US

V. Phone/Fax

Practice location:
  • Phone: 561-783-6163
  • Fax:
Mailing address:
  • Phone: 561-783-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAIDA A FLOREXIL
Title or Position: CEO
Credential:
Phone: 561-619-0425