Provider Demographics
NPI:1801188305
Name:PANGALLO, SIBLEA FAY (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:SIBLEA
Middle Name:FAY
Last Name:PANGALLO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:SIBLEA
Other - Middle Name:FAY
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:15059 N. SCOTTSDALE ROAD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254
Mailing Address - Country:US
Mailing Address - Phone:602-778-3601
Mailing Address - Fax:602-445-9390
Practice Address - Street 1:462 GRIDER STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-961-6995
Practice Address - Fax:716-204-4501
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014731363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical