Annette Gina Mangiameli, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

34289 Issued in TX

Practice address

4349 Jeker Dr
Plano, TX 75074-3571

Phone

(619) 762-8909

NPI assigned

May 23, 2011

Last updated

May 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Annette Gina Edwards Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: annette.mangiameli.1@30520.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Doctor on Demand Professionals P C

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1174931448

  TX

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1063705101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4349 JEKER DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750743571",
            "telephone_number": "619-762-8909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4349 JEKER DR",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750743571",
            "telephone_number": "619-762-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGIAMELI",
        "first_name": "ANNETTE",
        "middle_name": "GINA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-23",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17997",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "34289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2843021",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNETTE",
            "last_name": "EDWARDS",
            "middle_name": "GINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Derek Dunn Manelski
• Manes by Madeline LLC
• Deborah Cook Maness, LPC
• Kiran Kumar R Mangalpally, M.D.
• Joshua Lucas Mangels
• Shikaripur D Manjunath, M.D.,
• Tracye Manley, LCSW-S
• Katelynn Mann, MSN, FNP
• Sarabjot Jyoti Mann, DDS
• Todd Robert Mann, R.EEGT, CNIM

• Clinical Psychologist in Plano, TX
• Providers in Plano, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.