Provider Demographics
NPI:1699383646
Name:MONDELUS, FABIENNE (PA-C)
Entity type:Individual
Prefix:
First Name:FABIENNE
Middle Name:
Last Name:MONDELUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W RED OAK LN STE 310A
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3603
Mailing Address - Country:US
Mailing Address - Phone:914-719-6079
Mailing Address - Fax:
Practice Address - Street 1:82-68 164TH ST, JAMAICA,NY
Practice Address - Street 2:QUEENS HOSPITAL CENTER
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11432-2929
Practice Address - Country:US
Practice Address - Phone:718-883-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant