NPIMap

Organization Active NPI

Mango Wellness LLC

Doing business as Mangowellness

  • Multi-Specialty Clinic/Center
  • Saint Cloud, FL
National Provider Identifier
1912570987
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MANGO WELLNESS LLC
Doing business as
Mangowellness
Practice address
2801 13TH St
Saint Cloud, FL 34769-4134
Phone
(407) 593-2958
Fax
(407) 593-2957
NPI assigned
Jul 19, 2021
Organization subpart
Yes
Parent organization
MANGOWELLNESS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Siby Thomas Puthenpurayil, PHARMDNPI 1003181033
Title
Owner/Authorized Official
Phone
(407) 593-2958

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

2801 13TH St
Saint Cloud, FL 34769-4134

Mailing address

2801 13TH St
Saint Cloud, FL 34769-4134
Phone (407) 593-2958

Other names 1

  • MANGOWELLNESS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211018000865 FL Part B Supplier - Clinic/Group Practice 9931507266 Receives reassigned benefits from 5 practitioners
Practice locations: Saint Cloud, FL

National Provider Directory

National Provider Directory
Part of
Mango Wellness LLC

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1912570987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 13TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347694134",
            "telephone_number": "407-593-2958",
            "fax_number": "407-593-2957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 13TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347694134",
            "telephone_number": "407-593-2958",
            "fax_number": "407-593-2957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGO WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MANGOWELLNESS LLC",
        "enumeration_date": "2021-07-19",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "PUTHENPURAYIL",
        "authorized_official_first_name": "SIBY",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "407-593-2958",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MANGOWELLNESS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.