Provider Demographics
NPI:1801690359
Name:MANNING, SHALISE
Entity type:Individual
Prefix:
First Name:SHALISE
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 N SILVER TREE CT
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3562
Mailing Address - Country:US
Mailing Address - Phone:909-566-8402
Mailing Address - Fax:
Practice Address - Street 1:3834 N SILVER TREE CT
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-3562
Practice Address - Country:US
Practice Address - Phone:909-566-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker