Shannon Manley

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS019573 Issued in PA

Practice address

3901 S Atherton St Ste 5
State College, PA 16801-8324

Phone

(814) 466-7921

Fax

(814) 466-6570

NPI assigned

Dec 7, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

State licenses

Practice roles

Locations

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

• Mount Nittany Medical Center Health Services Inc

  • Internal Medicine Physician
  • State College, PA
  • NPI 1598992554
  Medicare reassignment NPD

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

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1487169835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 S ATHERTON ST STE 5",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168018324",
            "telephone_number": "814-466-7921",
            "fax_number": "814-466-6570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 S ATHERTON ST STE 5",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168018324",
            "telephone_number": "814-466-7921",
            "fax_number": "814-466-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANLEY",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "PA",
            "license": "PS019573",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS019573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mana Life Counseling LLC
• Donald F. Mandetta, M.D.
• Brooke Nicole Maneval, LAT, ATC
• Eileen M. Maney, PA-C
• Mark D Maney, PA
• Monica D Manning, CCC-SLP
• Jiannong Mao
• Emma Evangelina Maras-Ramassini, LSW
• Adam Jason Marcovitch, MD
• Erica K Marden, M.D.

• Psychologist in State College, PA
• Providers in State College, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; 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.