Provider Demographics
NPI:1942742903
Name:MANDEL, SHIRA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 BEACH 12TH ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:732-979-1700
Mailing Address - Fax:
Practice Address - Street 1:1254 BEACH 12TH ST
Practice Address - Street 2:APT 2C
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4710
Practice Address - Country:US
Practice Address - Phone:732-979-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist