Individual
INDIA MANCUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
141 WEBB DR STE 300, DAVENPORT, FL 33837-3951
(863) 422-0020
Mailing address
141 WEBB DR STE 300, DAVENPORT, FL 33837-3951
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9119710
FL
Other
Enumeration date
05/04/2023
Last updated
01/23/2025
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