Provider Demographics
NPI:1982040754
Name:STANIS, MANDY
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:STANIS
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 1:25145 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-1402
Mailing Address - Country:US
Mailing Address - Phone:708-307-5462
Mailing Address - Fax:
Practice Address - Street 1:25145 SPRING ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-1402
Practice Address - Country:US
Practice Address - Phone:708-307-5462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist