Provider Demographics
NPI:1215098546
Name:SANGIACOMO, ROXANN MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ROXANN
Middle Name:MARIA
Last Name:SANGIACOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 DANIELS PKWY STE 29-377
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7513
Mailing Address - Country:US
Mailing Address - Phone:239-850-2468
Mailing Address - Fax:239-768-6242
Practice Address - Street 1:6900 DANIELS PKWY STE 29-377
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7513
Practice Address - Country:US
Practice Address - Phone:239-850-2468
Practice Address - Fax:239-768-6242
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME569442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11190OtherBLUE CROSS BLUE SHIELD
FL11190Medicare ID - Type Unspecified
E54355Medicare UPIN