Basic Information
Provider Information | |||||||||
NPI: | 1609156975 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MANGINANI | ||||||||
FirstName: | SRIDEVI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 14690 SPRING HILL DR | ||||||||
Address2: | STE 305 | ||||||||
City: | SPRING HILL | ||||||||
State: | FL | ||||||||
PostalCode: | 346098102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3522775348 | ||||||||
FaxNumber: | 3526062857 | ||||||||
Practice Location | |||||||||
Address1: | 5350 SPRING HILL DR | ||||||||
Address2: |   | ||||||||
City: | SPRING HILL | ||||||||
State: | FL | ||||||||
PostalCode: | 346064562 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3526888116 | ||||||||
FaxNumber: | 3526869477 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/18/2011 | ||||||||
LastUpdateDate: | 01/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME1102563 | FL | N |   | Allopathic & Osteopathic Physicians | General Practice |   | 282N00000X | ME110263 | FL | N |   | Hospitals | General Acute Care Hospital |   | 282NC0060X | ME110263 | FL | N |   | Hospitals | General Acute Care Hospital | Critical Access | 282NR1301X | ME110263 | FL | N |   | Hospitals | General Acute Care Hospital | Rural | 207R00000X | ME110263 | FL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.