Provider Demographics
NPI:1689112500
Name:MANDELARIS, CHRISTINA M
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:MANDELARIS
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 1:8361 BLOCK HOUSE WAY
Mailing Address - Street 2:APT. 234
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-0900
Mailing Address - Country:US
Mailing Address - Phone:336-601-6080
Mailing Address - Fax:
Practice Address - Street 1:8361 BLOCK HOUSE WAY
Practice Address - Street 2:APT. 234
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-0900
Practice Address - Country:US
Practice Address - Phone:336-601-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-11
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist