Provider Demographics
NPI:1437389699
Name:MANSDORF, SHARON LOUISE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LOUISE
Last Name:MANSDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SWISSVALE
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1518
Mailing Address - Country:US
Mailing Address - Phone:317-652-3156
Mailing Address - Fax:
Practice Address - Street 1:200 ELM ST
Practice Address - Street 2:
Practice Address - City:SWISSVALE
Practice Address - State:PA
Practice Address - Zip Code:15218-1518
Practice Address - Country:US
Practice Address - Phone:317-652-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011087174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC011087OtherSTATE LICENSE