Provider Demographics
NPI:1073032561
Name:MANELA, SANDRA LYNN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:MANELA
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 1:507 MARY ST
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-4044
Mailing Address - Country:US
Mailing Address - Phone:337-912-3013
Mailing Address - Fax:
Practice Address - Street 1:2110 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7864
Practice Address - Country:US
Practice Address - Phone:337-475-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator