Provider Demographics
NPI:1508263336
Name:MANDEL, SHAWN JARED (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:JARED
Last Name:MANDEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 ITHACA LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2929
Mailing Address - Country:US
Mailing Address - Phone:917-572-5137
Mailing Address - Fax:
Practice Address - Street 1:4902 ITHACA LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2929
Practice Address - Country:US
Practice Address - Phone:917-572-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 1204103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool