Provider Demographics
NPI:1790802155
Name:MANITSAS, SARAH CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CHRISTINE
Last Name:MANITSAS
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 1:1305 S FORT HARRISON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3301
Mailing Address - Country:US
Mailing Address - Phone:727-631-0915
Mailing Address - Fax:727-631-0916
Practice Address - Street 1:1305 S FORT HARRISON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-631-0915
Practice Address - Fax:727-631-0916
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103410207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7099691OtherAETNA
FL001546800Medicaid
FL001546800Medicaid