Healthcare Provider Details

I. General information

NPI: 1811770613
Provider Name (Legal Business Name): BRE'ONNA CECELIA MANDELES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRE'ONNA MCNEAL

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ATLANTIC ST SW
WASHINGTON DC
20032-2350
US

IV. Provider business mailing address

5641 HARRINGTON FALLS LN UNIT E
ALEXANDRIA VA
22312-4029
US

V. Phone/Fax

Practice location:
  • Phone: 202-407-7747
  • Fax:
Mailing address:
  • Phone: 904-707-9326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186757
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1048548
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: