Provider Demographics
NPI:1750310488
Name:MAMONE, VINCENT JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:MAMONE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1627 US HIGHWAY 1
Mailing Address - Street 2:STE 101
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3462
Mailing Address - Country:US
Mailing Address - Phone:772-581-9551
Mailing Address - Fax:772-581-9646
Practice Address - Street 1:309 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1205
Practice Address - Country:US
Practice Address - Phone:407-324-5035
Practice Address - Fax:407-321-5266
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2021-11-30
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Provider Licenses
StateLicense IDTaxonomies
FLOS6401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53004Medicare UPIN