Provider Demographics
NPI:1033739099
Name:MANANGON, MEGHAN LOUISE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LOUISE
Last Name:MANANGON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:LOUISE
Other - Last Name:SHALVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:1820 S SARTAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:196 CLINTON AVE APT D34
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3417
Practice Address - Country:US
Practice Address - Phone:631-332-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706711163WM0102X
NY405697363LP0808X
NY135846163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant