Provider Demographics
NPI:1235681404
Name:MANZELLA, ELIAS LIBORIO (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:LIBORIO
Last Name:MANZELLA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SHEPARD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-3449
Mailing Address - Country:US
Mailing Address - Phone:716-269-4420
Mailing Address - Fax:
Practice Address - Street 1:37 SHEPARD ST APT 3
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-3449
Practice Address - Country:US
Practice Address - Phone:716-269-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical