Healthcare Provider Details

I. General information

NPI: 1144723743
Provider Name (Legal Business Name): JOAN ANDREA MANDELSON MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOAN ANDREA MENDEZ

II. Dates (important events)

Enumeration Date: 03/10/2018
Last Update Date: 03/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S CARLIN SPRINGS RD
ARLINGTON VA
22204-1044
US

IV. Provider business mailing address

601 S CARLIN SPRINGS RD
ARLINGTON VA
22204-1044
US

V. Phone/Fax

Practice location:
  • Phone: 703-271-8800
  • Fax:
Mailing address:
  • Phone: 703-271-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86049917
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: