Provider Demographics
NPI:1093846503
Name:MANGAN, SHEILA (PT)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:MANGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BIDDLE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3969
Mailing Address - Country:US
Mailing Address - Phone:302-838-4700
Mailing Address - Fax:302-838-4710
Practice Address - Street 1:1401 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2763
Practice Address - Country:US
Practice Address - Phone:302-477-4305
Practice Address - Fax:302-477-4306
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006249L225100000X
DEJ10002252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist