Provider Demographics
NPI:1356923064
Name:MANEA, MATEI NICHOLAS (PA-C)
Entity type:Individual
Prefix:
First Name:MATEI
Middle Name:NICHOLAS
Last Name:MANEA
Suffix:
Gender:
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 1:3913 NORTHWATER TRL
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-3882
Mailing Address - Country:US
Mailing Address - Phone:203-525-8800
Mailing Address - Fax:
Practice Address - Street 1:3537 S INTERSTATE 35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6800
Practice Address - Country:US
Practice Address - Phone:940-287-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16834363AS0400X
CT00000000208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT011253OtherEMT
TXPA16834OtherPHYSICIAN ASSISTANT
CT5291OtherPHYSICIAN ASSISTANT