Healthcare Provider Details

I. General information

NPI: 1750375861
Provider Name (Legal Business Name): SVITLANA J MANDZY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 KRESGE WAY SUITE 410
LOUISVILLE KY
40207-4652
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-7462
  • Fax: 502-212-7551
Mailing address:
  • Phone: 502-253-4900
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number36466
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36466
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: