Provider Demographics
NPI:1285663112
Name:MANNEH, SARAH MANALANSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MANALANSAN
Last Name:MANNEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:#210
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3183
Mailing Address - Country:US
Mailing Address - Phone:763-587-7000
Mailing Address - Fax:763-587-7015
Practice Address - Street 1:5700 BOTTINEAU BLVD
Practice Address - Street 2:#210
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3183
Practice Address - Country:US
Practice Address - Phone:763-587-7000
Practice Address - Fax:763-587-7015
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1797934OtherAMERICA'S PPO
MNHP38103OtherHEALTHPARTNERS
MN7613467OtherAETNA INS
MN351J1MAOtherBCBS OF MN
MN1034191OtherPREFERRED ONE
MN702605600Medicaid
MN0703468OtherMEDICA #
MN171112OtherUCARE MN
MNHP38103OtherHEALTHPARTNERS
MN0703468OtherMEDICA #
MN7613467OtherAETNA INS