Provider Demographics
NPI:1144723743
Name:MANDELSON, JOAN ANDREA (MS RD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ANDREA
Last Name:MANDELSON
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:ANDREA
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 S CARLIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1044
Mailing Address - Country:US
Mailing Address - Phone:703-271-8800
Mailing Address - Fax:
Practice Address - Street 1:601 S CARLIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1044
Practice Address - Country:US
Practice Address - Phone:703-271-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86049917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered