Healthcare Provider Details

I. General information

NPI: 1508458068
Provider Name (Legal Business Name): SARAH MANDEL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W 21ST ST FL 4
NEW YORK NY
10010-6923
US

IV. Provider business mailing address

245 E 40TH ST APT 27G
NEW YORK NY
10016-1771
US

V. Phone/Fax

Practice location:
  • Phone: 212-645-6903
  • Fax:
Mailing address:
  • Phone: 610-357-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: