Provider Demographics
NPI:1215783469
Name:MANGIAMELI-MULLINS, SHELLI DAWN (LCPM)
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:DAWN
Last Name:MANGIAMELI-MULLINS
Suffix:
Gender:F
Credentials:LCPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43W132 BEITH RD
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9567
Mailing Address - Country:US
Mailing Address - Phone:313-627-2992
Mailing Address - Fax:
Practice Address - Street 1:626 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3237
Practice Address - Country:US
Practice Address - Phone:313-627-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041533312163WX0003X
IL295000019176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Single Specialty