Provider Demographics
NPI:1093822629
Name:MAMMAS, ADAMANTIA ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ADAMANTIA
Middle Name:ANNA
Last Name:MAMMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 S HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3432
Mailing Address - Country:US
Mailing Address - Phone:407-455-0829
Mailing Address - Fax:
Practice Address - Street 1:5900 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3716
Practice Address - Country:US
Practice Address - Phone:407-398-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55533207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine