Provider Demographics
NPI:1306111505
Name:SHANDOR, NADINE (MS, LPC)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:SHANDOR
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LARRY HOLMES DR STE 213
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-7727
Mailing Address - Country:US
Mailing Address - Phone:908-619-1155
Mailing Address - Fax:
Practice Address - Street 1:101 LARRY HOLMES DR STE 213
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-7727
Practice Address - Country:US
Practice Address - Phone:908-619-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional