Provider Demographics
NPI:1477100824
Name:MANDALA, CARLY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:MANDALA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4898
Mailing Address - Country:US
Mailing Address - Phone:212-606-1875
Mailing Address - Fax:917-260-3323
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4898
Practice Address - Country:US
Practice Address - Phone:212-606-1875
Practice Address - Fax:917-260-3323
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical