Provider Demographics
NPI:1467786780
Name:MANSUETO, MICHELLE F
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:F
Last Name:MANSUETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 HIBBS GROVE TERR
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330
Mailing Address - Country:US
Mailing Address - Phone:954-400-5806
Mailing Address - Fax:954-880-0776
Practice Address - Street 1:9800 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6552
Practice Address - Country:US
Practice Address - Phone:954-400-5806
Practice Address - Fax:954-880-0776
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist