Basic Information
| Provider Information | |||||||||
| NPI: | 1043453616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELEON MANSSON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8340 COLLIER BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341143589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393484221 | ||||||||
| FaxNumber: | 2393484337 | ||||||||
| Practice Location | |||||||||
| Address1: | 8340 COLLIER BLVD STE 305 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393484221 | ||||||||
| FaxNumber: | 2393484337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MB08553100 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 25MB08553100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0201669 | 05 | NJ | MEDICAID |