MEDICARE: MR. JOSEPH SANGILLO

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1376884023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH SANGILLO

Provider Business Mailing Address
First Line	:	17717 VAIL ST
Second Line	:	APT 1316
City	:	DALLAS
State	:	TX
Zip	:	75287-6400
Country	:	US
Telephone Number	:	469-471-1878
Fax Number	:

Provider Business Practice Location Address
First Line	:	17717 VAIL ST
Second Line	:	APT 1316
City	:	DALLAS
State	:	TX
Zip	:	75287-6400
Country	:	US
Telephone Number	:	469-471-1878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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