Provider Demographics
NPI:1205990694
Name:MANGALAT, SHEETAL NIRANJAN (MD)
Entity type:Individual
Prefix:
First Name:SHEETAL
Middle Name:NIRANJAN
Last Name:MANGALAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEETAL
Other - Middle Name:NIRANJAN
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3292 THOMPSON BRIDGE RD STE 371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-1561
Mailing Address - Country:US
Mailing Address - Phone:770-982-2332
Mailing Address - Fax:770-972-4104
Practice Address - Street 1:2295 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-982-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088261208000000X
NC2008-00639208000000X, 208M00000X
GA064859208M00000X, 208000000X
OH35-088261208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52507116OtherBCBS
GA1205990694OtherTRICARE STANDARD (SOUTH)
GA7534282OtherCIGNA
GA562994OtherWELLCARE OF GEORGIA
GA7037841OtherAETNA
GA01364310OtherAMERIGROUP
GA889794953AMedicaid
GA202I375779Medicare PIN