Provider Demographics
NPI:1619925484
Name:MABANTA, SHEILAINE R (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILAINE
Middle Name:R
Last Name:MABANTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SHEILAINE
Other - Middle Name:
Other - Last Name:RODRIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49725 COUNTY 83
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-5280
Mailing Address - Country:US
Mailing Address - Phone:218-894-1515
Mailing Address - Fax:218-894-8767
Practice Address - Street 1:49725 COUNTY 83
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-5280
Practice Address - Country:US
Practice Address - Phone:218-894-1515
Practice Address - Fax:218-894-8767
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME742012085R0001X, 174400000X
TXP69992085R0001X
MN650602085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328624701Medicaid
FL259085900Medicaid
TX295100YS65OtherMEDICARE ID
FLH12849Medicare UPIN
TX328624701Medicaid