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NPI Code Detail

MEDICARE: SHREYA MANDLOI BS

MEDICARE: SHREYA MANDLOI BS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Y00000XOtolaryngology PhysicianMT233731PA

General Provider Information

NPI Number : 1558100602
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHREYA MANDLOI BS
Provider Business Mailing Address
First Line : 60 N 36TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-5639
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 60 N 36TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19104-5639
Country : US
Telephone Number : 215-991-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2024
Last Update Date : 08/30/2025

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