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General NPI Number Information
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NPI Number | 1689914160
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Entity Type | Individual
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Provider Name | JUSTIN MANDEL L.AC
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Gender | Male
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 1105 7TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33705-1309
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Country | US
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Telephone | 727-606-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 7TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33705-1309
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Country | US
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Telephone | 727-606-8700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 002379-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP3562
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License Number State | FL
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