Individual
SIDNEY SHANE MANGELSDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AG-ACNP
Contact information
Practice address
500 W THOMAS RD STE 400, PHOENIX, AZ 85013-4238
(602) 406-3874
(602) 406-2335
Mailing address
PO BOX 33269, PHOENIX, AZ 85067-3269
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP8394
AZ
363LA2200X
Adult Health Nurse Practitioner
AP8394
AZ
363LG0600X
Gerontology Nurse Practitioner
AP8394
AZ
Other
Enumeration date
01/20/2016
Last updated
01/09/2025
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