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NPI Code Detail

MEDICARE: SANDRA MANCILLA MD

MEDICARE: SANDRA MANCILLA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD432023PA
2207Q00000XFamily Medicine PhysicianC1-0008615DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033247325
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA MANCILLA MD
Provider Business Mailing Address
First Line : 30549 SUSSEX HWY
Second Line :
City : LAUREL
State : DE
Zip : 19956-3891
Country : US
Telephone Number : 302-990-3322
Fax Number : 302-875-2560
Provider Business Practice Location Address
First Line : 30549 SUSSEX HWY
Second Line :
City : LAUREL
State : DE
Zip : 19956-3891
Country : US
Telephone Number : 302-990-3322
Fax Number : 302-875-2560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 07/21/2022

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Directions to “ SANDRA MANCILLA MD” Practice Location

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