Provider Demographics
NPI:1053797324
Name:MATTEI, MANISHA BRIEL
Entity type:Individual
Prefix:MS
First Name:MANISHA
Middle Name:BRIEL
Last Name:MATTEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 TROUBLE CREEK RD STE 228
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4965
Mailing Address - Country:US
Mailing Address - Phone:727-458-0192
Mailing Address - Fax:727-484-6870
Practice Address - Street 1:5006 TROUBLE CREEK RD STE 228
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652
Practice Address - Country:US
Practice Address - Phone:727-458-0192
Practice Address - Fax:727-484-6870
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
FL241729376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020070000Medicaid
FL022093300Medicaid