MEDICARE: CARDIOVASCULAR SPECIALISTS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	38686	OTHER		BC/BS

General Provider Information

NPI Number	:	1336192848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR SPECIALISTS PA

Provider Business Mailing Address
First Line	:	305 N MANGOUSTINE AVE
Second Line	:	STE 200
City	:	SANFORD
State	:	FL
Zip	:	32771-1004
Country	:	US
Telephone Number	:	407-321-1415
Fax Number	:	407-321-1597

Provider Business Practice Location Address
First Line	:	305 N MANGOUSTINE AVE
Second Line	:	STE 200
City	:	SANFORD
State	:	FL
Zip	:	32771-1004
Country	:	US
Telephone Number	:	407-321-1415
Fax Number	:	407-321-1597

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CECELIA R. BRYANT
Credential	:
Telephone Number	:	407-321-1415

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/18/2008

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Directions to “CARDIOVASCULAR SPECIALISTS PA ” Practice Location

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