| Mango Wellness Llc | |
|
2801 13th St Saint Cloud FL 34769-4134 | |
| (407) 593-2958 | |
| (407) 593-2957 |
| Full Name | Mango Wellness Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2801 13th St, Saint Cloud, Florida |
| Authorized Official Name and Position | Siby Thomas Puthenpurayil (OWNER/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4075932958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mango Wellness Llc 2801 13th St Saint Cloud FL 34769-4134 Ph: (407) 593-2958 | Mango Wellness Llc 2801 13th St Saint Cloud FL 34769-4134 Ph: (407) 593-2958 |
| NPI Number | 1912570987 |
|---|---|
| Provider Enumeration Date | 07/19/2021 |
| Last Update Date | 09/20/2021 |
| Medicare PECOS PAC ID | 9931507266 |
|---|---|
| Medicare Enrollment ID | O20211018000865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912570987 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Miguel A Davila |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184797482 PECOS PAC ID: 4880791631 Enrollment ID: I20211104001202 |
| Provider Name | Sheeja Jacob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174100556 PECOS PAC ID: 1759789084 Enrollment ID: I20230526000090 |
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