Provider Demographics
NPI:1356363212
Name:TREASURE COAST SLEEP DISORDERS LLC
Entity type:Organization
Organization Name:TREASURE COAST SLEEP DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMANGAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-232-9990
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34958-0187
Mailing Address - Country:US
Mailing Address - Phone:772-232-9990
Mailing Address - Fax:772-232-9989
Practice Address - Street 1:642 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4750
Practice Address - Country:US
Practice Address - Phone:772-232-9990
Practice Address - Fax:772-232-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7011Medicare ID - Type Unspecified