Healthcare Provider Details

I. General information

NPI: 1235626185
Provider Name (Legal Business Name): SAMANTHA JILL MANDEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 308
RALEIGH NC
27607-7514
US

IV. Provider business mailing address

5801 POSTAL RD
CLEVELAND OH
44181-2184
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-7450
  • Fax: 919-781-8324
Mailing address:
  • Phone: 561-300-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2022-01508
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: