Provider Demographics
NPI:1639605090
Name:MANDELL, PATRICIA F (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:F
Last Name:MANDELL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 37TH ST STE E100
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7304
Mailing Address - Country:US
Mailing Address - Phone:772-569-9747
Mailing Address - Fax:772-569-9979
Practice Address - Street 1:787 37TH ST STE E100
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7304
Practice Address - Country:US
Practice Address - Phone:772-569-9747
Practice Address - Fax:772-569-9979
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist