Provider Demographics
NPI:1073544318
Name:SANGILLO, MARIA R (DC, CSSP)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:R
Last Name:SANGILLO
Suffix:
Gender:F
Credentials:DC, CSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 CREIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7218
Mailing Address - Country:US
Mailing Address - Phone:850-473-8080
Mailing Address - Fax:850-473-8816
Practice Address - Street 1:2110 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7218
Practice Address - Country:US
Practice Address - Phone:850-473-8080
Practice Address - Fax:850-473-8816
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4142111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3460844OtherTAX ID
FL69967Medicare UPIN
FL59-3460844OtherTAX ID