Provider Demographics
NPI:1649528043
Name:KANDELL, MARY ANNE (R N)
Entity type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:
Last Name:KANDELL
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AMYS PATH
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-4131
Mailing Address - Country:US
Mailing Address - Phone:631-653-3887
Mailing Address - Fax:631-653-3911
Practice Address - Street 1:5 AMYS PATH
Practice Address - Street 2:
Practice Address - City:EAST QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11942-4131
Practice Address - Country:US
Practice Address - Phone:631-653-3887
Practice Address - Fax:631-653-3911
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY369668-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health