MEDICARE: SIRENISEA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111NI0013X	Independent Medical Examiner Chiropractor
2	171100000X	Acupuncturist
3	208D00000X	General Practice Physician
4	225700000X	Massage Therapist
5	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1588488944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIRENISEA LLC

Provider Business Mailing Address
First Line	:	1696 SE HILLMOOR DR STE C
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-335-3222
Fax Number	:	772-335-3793

Provider Business Practice Location Address
First Line	:	1696 SE HILLMOOR DR STE C
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-335-3222
Fax Number	:	772-335-3793

Authorized Official
Title or Position	:	OWNER
Name	:	MEAGHAN CROSBY
Credential	:
Telephone Number	:	772-335-3222

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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Directions to “SIRENISEA LLC ” Practice Location

Language	Start Address	Practice Location

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