SIDNEY SHANE MANGELSDORF AG-ACNP NPI 1871950980

NPI Information

NPI: 1871950980
Provider Name: SIDNEY SHANE MANGELSDORF, AG-ACNP
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
500 W THOMAS RD STE 400
PHOENIX, AZ
ZIP 85013
Phone: (602) 406-3874
Get Directions

Sidney Shane Mangelsdorf, AG-ACNP is a gerontology nurse practitioner in Phoenix, AZ with 9 years of experience. Sidney Shane Mangelsdorf, AG-ACNP NPI is 1871950980. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

500 W THOMAS RD STE 400
PHOENIX, AZ
ZIP 85013
Phone: (602) 406-3874
Fax: (602) 406-2335

The NPI 1871950980 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/20/2016 and was last updated on 9/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2100X	Nurse Practitioner	Acute Care	AP8394	ARIZONA	No
2	363LG0600X	Nurse Practitioner	Gerontology	AP8394	ARIZONA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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