MEDICARE: MAGAMBO'S PEACEFUL PALACE, PC

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1215801006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGAMBO'S PEACEFUL PALACE, PC

Provider Business Mailing Address
First Line	:	26 THOMASTON DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-1406
Country	:	US
Telephone Number	:	814-691-1618
Fax Number	:	412-207-3551

Provider Business Practice Location Address
First Line	:	26 THOMASTON DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-1406
Country	:	US
Telephone Number	:	814-691-1618
Fax Number	:	412-207-3551

Authorized Official
Title or Position	:	OWNER
Name	:	SHANEISA MAGAMBO
Credential	:	LBS
Telephone Number	:	814-691-1618

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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