Healthcare Provider Details

I. General information

NPI: 1437389699
Provider Name (Legal Business Name): SHARON LOUISE MANSDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 03/09/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELM ST
SWISSVALE PA
15218-1518
US

IV. Provider business mailing address

200 ELM ST
SWISSVALE PA
15218-1518
US

V. Phone/Fax

Practice location:
  • Phone: 317-652-3156
  • Fax:
Mailing address:
  • Phone: 317-652-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOC011087
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: