Provider Demographics
NPI:1114626249
Name:MANALEL, SHANNA MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:MARY
Last Name:MANALEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 FOUNTAINBROOK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4835
Mailing Address - Country:US
Mailing Address - Phone:281-896-3338
Mailing Address - Fax:
Practice Address - Street 1:5243 FOUNTAINBROOK LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4835
Practice Address - Country:US
Practice Address - Phone:281-896-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist