Healthcare Provider Details

I. General information

NPI: 1912718065
Provider Name (Legal Business Name): MIKHAYLA BROOKE MANGANELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 OLD HICKORY BLVD STE B
HERMITAGE TN
37076-2588
US

IV. Provider business mailing address

1116 BELVIDERE DR
NASHVILLE TN
37204-3916
US

V. Phone/Fax

Practice location:
  • Phone: 615-391-9006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1067
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: