Provider Demographics
NPI:1326706276
Name:SHAPIT, MAGNOLIA MENDOZA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MAGNOLIA
Middle Name:MENDOZA
Last Name:SHAPIT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:MAGNOLIA
Other - Middle Name:MEDINA
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:404 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5622
Mailing Address - Country:US
Mailing Address - Phone:484-973-6661
Mailing Address - Fax:610-631-3408
Practice Address - Street 1:404 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5622
Practice Address - Country:US
Practice Address - Phone:484-973-6661
Practice Address - Fax:610-631-3408
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health