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Individual
MANDY XI
Active
Individual
MANDY XI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022968
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022968
NYS LICENSING DEPARTMENT FOR PA-C
NY
01
—
1157035
NCCPA
NY
01
—
440014956
DRIVER LICENSE
NY
Enumeration date
11/06/2018
Last updated
07/08/2026
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