Healthcare Provider Details

I. General information

NPI: 1821962879
Provider Name (Legal Business Name): MANDALAY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 GOLF RD STE 1200
ROLLING MEADOWS IL
60008-4229
US

IV. Provider business mailing address

1600 GOLF RD STE 1200
ROLLING MEADOWS IL
60008-4229
US

V. Phone/Fax

Practice location:
  • Phone: 773-395-0937
  • Fax:
Mailing address:
  • Phone: 773-395-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MYA YEE NANDAR
Title or Position: OWNER
Credential:
Phone: 808-989-9192