Organization
ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANDRE SHONDALE MOSTELLA CP (OWNER)
(225) 316-5444
Entity
Organization
Contact information
Practice address
1050 N FLOWOOD DR STE B4, JACKSON, MS 39232-9738
(769) 777-7440
(985) 256-2599
Mailing address
7754 FLORIDA BLVD, BATON ROUGE, LA 70806-4706
(225) 243-9736
(985) 256-2599
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1143
1143
MS
Enumeration date
08/19/2020
Last updated
09/06/2023
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