Provider Demographics
NPI:1093500324
Name:MANGANARO, MARY ROSE (MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:MANGANARO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 PINE WARBLER PL UNIT 1202
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1530
Mailing Address - Country:US
Mailing Address - Phone:617-699-3630
Mailing Address - Fax:
Practice Address - Street 1:1420 PINE WARBLER PL UNIT 1202
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1530
Practice Address - Country:US
Practice Address - Phone:617-699-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist