Provider Demographics
NPI:1689188385
Name:MANDRY, MARY KATHLEEN (RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN
Last Name:MANDRY
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:KATHLEEN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD/N
Mailing Address - Street 1:1510 CITRUS MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4547
Mailing Address - Country:US
Mailing Address - Phone:407-480-4830
Mailing Address - Fax:407-480-4834
Practice Address - Street 1:1510 CITRUS MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4547
Practice Address - Country:US
Practice Address - Phone:407-480-4830
Practice Address - Fax:407-480-4834
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered