Provider Demographics
NPI:1154484764
Name:MANDELI, KATHRYN G (LPN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:G
Last Name:MANDELI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3515
Mailing Address - Country:US
Mailing Address - Phone:516-799-2216
Mailing Address - Fax:
Practice Address - Street 1:950 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3510
Practice Address - Country:US
Practice Address - Phone:516-822-6111
Practice Address - Fax:516-396-0553
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130939164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse