Individual
SHARON LOUISE MANSDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 ELM ST, SWISSVALE, PA 15218-1518
(317) 652-3156
Mailing address
200 ELM ST, SWISSVALE, PA 15218-1518
(317) 652-3156
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OC011087
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OC011087
STATE LICENSE
PA
Enumeration date
07/22/2009
Last updated
03/09/2022
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