Provider Demographics
NPI:1760199871
Name:MANDELL, ALLISON LEAH (MS, RD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEAH
Last Name:MANDELL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OAKWOOD VLG APT 7
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-8942
Mailing Address - Country:US
Mailing Address - Phone:732-439-0083
Mailing Address - Fax:
Practice Address - Street 1:109 OAKWOOD VLG APT 7
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-8942
Practice Address - Country:US
Practice Address - Phone:732-439-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86254321133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty