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Individual
SHIRLEY S MANDEVILLE
Active
Individual
SHIRLEY S MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F331695-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01791166
—
NY
01
—
9512361
INDEPENDENT HEALTH
NY
01
—
P019331695
ROCH BS
NY
Enumeration date
05/20/2006
Last updated
07/18/2011
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