Healthcare Provider Details

I. General information

NPI: 1619925484
Provider Name (Legal Business Name): SHEILAINE R MABANTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SHEILAINE RODRIGO

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49725 COUNTY 83
STAPLES MN
56479-5280
US

IV. Provider business mailing address

49725 COUNTY 83
STAPLES MN
56479-5280
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1515
  • Fax: 218-894-8767
Mailing address:
  • Phone: 218-894-1515
  • Fax: 218-894-8767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME74201
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberP6999
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number65060
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME74201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: