Provider Demographics
NPI:1659487536
Name:MANGANELLI, MONIQUE LENORE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:LENORE
Last Name:MANGANELLI
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 1:4701 N FEDERAL HWY
Mailing Address - Street 2:SUITE A-27
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4608
Mailing Address - Country:US
Mailing Address - Phone:954-938-9966
Mailing Address - Fax:954-938-8227
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:SUITE A-27
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4608
Practice Address - Country:US
Practice Address - Phone:954-938-9966
Practice Address - Fax:954-938-8227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111004207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIB740ZMedicare PIN
NHE12442Medicare UPIN