Provider Demographics
NPI:1174141097
Name:MANGALAMPALLY, SHILPA PRIYA
Entity type:Individual
Prefix:DR
First Name:SHILPA PRIYA
Middle Name:
Last Name:MANGALAMPALLY
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 1:5401 6TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2618
Mailing Address - Country:US
Mailing Address - Phone:253-756-5437
Mailing Address - Fax:
Practice Address - Street 1:5401 6TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2618
Practice Address - Country:US
Practice Address - Phone:253-759-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610869161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice