Provider Demographics
NPI:1710072723
Name:CARDELLO, CAROL MANDERS (CNS APRN BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MANDERS
Last Name:CARDELLO
Suffix:
Gender:F
Credentials:CNS APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18660 EAST BAGLEY ROAD
Mailing Address - Street 2:SUITE 405 PHASE II
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8492
Mailing Address - Country:US
Mailing Address - Phone:440-243-0530
Mailing Address - Fax:440-243-3351
Practice Address - Street 1:18660 EAST BAGLEY ROAD
Practice Address - Street 2:SUITE 405 PHASE II
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8492
Practice Address - Country:US
Practice Address - Phone:440-243-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN160804163WP0809X
OHNS02515364S00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q66431Medicare UPIN
Q66431Medicare UPIN