Provider Demographics
NPI:1487862827
Name:MCMANUS, SHANDA MONIQUE (MD)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:MONIQUE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3322
Mailing Address - Country:US
Mailing Address - Phone:732-530-2154
Mailing Address - Fax:
Practice Address - Street 1:18 LEONARDVILLE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2311
Practice Address - Country:US
Practice Address - Phone:732-671-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07399400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine