Provider Demographics
NPI:1972819464
Name:MANDEL, TARYN FELISE
Entity Type:Individual
Prefix:MISS
First Name:TARYN
Middle Name:FELISE
Last Name:MANDEL
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 1:11 WINDHAM LOOP
Mailing Address - Street 2:3CC
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5959
Mailing Address - Country:US
Mailing Address - Phone:718-982-0104
Mailing Address - Fax:
Practice Address - Street 1:2465 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5803
Practice Address - Country:US
Practice Address - Phone:718-370-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist