MEDICARE: MRS. SUKDAI MANGRU CNM

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	367A00000X	Advanced Practice Midwife	F000890	NY
2	367A00000X	Advanced Practice Midwife	ARNP2098022	FL

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720174352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUKDAI MANGRU CNM

Provider Business Mailing Address
First Line	:	6210 SCOTT ST
Second Line	:	UNIT 216
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3901
Country	:	US
Telephone Number	:	941-205-2666
Fax Number	:	941-205-2665

Provider Business Practice Location Address
First Line	:	6210 SCOTT ST
Second Line	:	UNIT 216
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-3901
Country	:	US
Telephone Number	:	941-205-2666
Fax Number	:	941-205-2665

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/22/2016

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