Healthcare Provider Details

I. General information

NPI: 1306240924
Provider Name (Legal Business Name): MANDY BERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MANDY LORENZ

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SLEEPY HOLLOW RD
BRIARCLIFF MANOR NY
10510-2516
US

IV. Provider business mailing address

1776 WOODSTEAD CT STE 208
THE WOODLANDS TX
77380-1480
US

V. Phone/Fax

Practice location:
  • Phone: 914-941-5100
  • Fax:
Mailing address:
  • Phone: 877-749-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341265-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: