Provider Demographics
NPI:1770217085
Name:MANUEL, VANDRIKA DELANIA
Entity Type:Individual
Prefix:MISS
First Name:VANDRIKA
Middle Name:DELANIA
Last Name:MANUEL
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 1:8786 N CREEK BLVD APT 6-11
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7218
Mailing Address - Country:US
Mailing Address - Phone:901-820-6782
Mailing Address - Fax:
Practice Address - Street 1:8786 N CREEK BLVD APT 6-11
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-7218
Practice Address - Country:US
Practice Address - Phone:901-820-6782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver