SIDNEY SHANE MANGELSDORF (NPI# 1871950980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871950980 |
| Entity Type | Individual |
| Full Name | SIDNEY SHANE MANGELSDORF |
| Credential | AG-ACNP |
| Practice Address |
500 W Thomas Rd Ste 400 Phoenix AZ 85013 |
| Mailing Address |
3030 N Central Ave Ste 1001 Phoenix AZ 85012-2716 |
| Practice Telephone | 6024063874 |
| Practice Fax Number | 6024062335 |
| Mailing Telephone | 6024064786 |
| Mailing Fax Number | 9166364358 |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2019-08-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
AP8394 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
AP8394 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 350 W Thomas Rd, Phoenix, AZ 850134409 | 6024063000 | |
| 500 W Thomas Rd Ste 400, Phoenix, AZ 85013 | 6024063874 | 6024062335 |
| Street Address |
500 W THOMAS RD STE 400 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750347563 | Jordan A Weinberg | Surgery | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013 | 2006-04-21 |
| 1417431818 | Nicole Marie Torres | Nurse Practitioner | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013-4238 | 2018-09-20 |
| 1356769459 | Jeanne Yvonne Parrish | Nurse Practitioner | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013-4238 | 2014-04-04 |
| 1629492236 | Erin Wilkinson | Nurse Practitioner | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013-4238 | 2014-02-18 |
| 1679825004 | Claire J Johnson | Physician Assistant | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013 | 2012-10-09 |
| 1306169313 | Derik Michael Alexander | Nurse Practitioner | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013 | 2010-03-04 |
| 1215160379 | Jordan Vernon Jacobs | Surgery | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013 | 2009-08-24 |
| 1811121403 | Kathryn Elise Coan | Surgery | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013-4238 | 2009-05-11 |
| 1982868519 | James N. Bogert | Surgery | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013 | 2008-07-14 |
| 1689871188 | Conrad Dizon Ballecer IIi | Surgery | 500 W Thomas Rd Ste 400, Phoenix, AZ 85013 | 2007-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043833700 | Marco Antonio Valdez Espinoza | Student in an Organized Health Care Education/Training Program | 500 W. Thomas Road, Suite 900 A, Phoenix, AZ 85013 | 2020-05-28 |
| 1518588292 | Santiago Garcia Ortiz | Student in an Organized Health Care Education/Training Program | 350w Thomas Rd St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013 | 2020-05-04 |
| 1356811970 | Lynne Shaunte Coleman | Nurse Practitioner | 3633 N 3rd Ave 2019, Phoenix, AZ 85013 | 2018-11-26 |
| 1467949156 | Solterra 3rd Indian School Operations, LLC | Assisted Living Facility | 4000 N 3rd Avenue, Phoenix, AZ 85013 | 2018-04-18 |
| 1083018345 | Romelda Antonio | Nurse Practitioner | 222 W Thomas Rd Ste 212, Phoenix, AZ 85013 | 2014-10-15 |
| 1760890131 | Emmitt Michael Thompson | General Practice | 822 West Earll Drive, Phoenix, AZ 85013 | 2014-07-29 |
| 1902218480 | Sreeja Biswas Roy | Internal Medicine | 350 W Thomas Road, Phoenix, AZ 85013 | 2014-06-02 |
| 1417381120 | Osama Qasim Agha | Internal Medicine | 350 W. Thomas Road, Suite 900a, Phoenix, AZ 85013 | 2013-08-29 |
| 1245679604 | Oculist Exceptional Eyewear Pllc | Optometrist | 5043-b N 7th Ave, Phoenix, AZ 85013 | 2013-06-19 |
| 1760829352 | Gina Wilding | Nurse Practitioner | 500 W Thomas Rd Ste 720, Phoenix, AZ 85013 | 2013-05-23 |
| Find all providers in zip 85013 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013552124 | Alliance With The Covenant of The Trinity Arizona Inc | Nurse Practitioner | 2 N Central Ave Fl 18, Phoenix, AZ 85004-2322 | 2019-11-12 |
| 1023222551 | Mary L Froehlich | Nurse Practitioner | 2930 E Camelback Rd, Phoenix, AZ 85016-4411 | 2007-05-10 |
| 1396898458 | The Elderly Advocate Inc. | Nurse Practitioner | 4040 E Mcdowell Rd, Suite # 214, Phoenix, AZ 85008-4414 | 2007-01-19 |
| 1245231042 | Sharolyn Liane Mcclurg | Nurse Practitioner | 2025 N 3rd St, Suite 170, Phoenix, AZ 85004-1471 | 2005-08-03 |
| 1417518564 | David S. Farrow | Nurse Practitioner | 4350 E Camelback Rd Ste F100, Phoenix, AZ 85018-8313 | 2019-06-27 |
| 1427542927 | William Fox Jr. | Nurse Practitioner | 9520 W Palm Ln, Phoenix, AZ 85037-4403 | 2018-06-18 |
| 1629519335 | Helen Tagormacon Ferrer-irwin | Nurse Practitioner | 2510 W Dunlap Ave, Ste 290, Phoenix, AZ 85021-2737 | 2017-03-14 |
| 1518411313 | Susanne Uhrig | Nurse Practitioner | 20040 N 19th Ave Ste A, Phoenix, AZ 85027-4256 | 2016-08-09 |
| 1881055291 | Carrie Jean Peterson | Nurse Practitioner | 625 N 6th St, Phoenix, AZ 85004 | 2016-03-11 |
| 1568829554 | Anne Bourgeois | Nurse Practitioner | 4550 E Bell Rd Ste 170, Phoenix, AZ 85032 | 2016-01-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.