Healthcare Provider Details

I. General information

NPI: 1184131617
Provider Name (Legal Business Name): HEATHER MARIE MANCINI LA.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E AFTON AVE STE F
YARDLEY PA
19067-1449
US

IV. Provider business mailing address

2318 BRYN MAWR AVE
ARDMORE PA
19003-2907
US

V. Phone/Fax

Practice location:
  • Phone: 610-850-2257
  • Fax: 856-494-1924
Mailing address:
  • Phone: 610-850-2257
  • Fax: 856-494-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK001248
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: