Provider Demographics
NPI:1689914160
Name:MANDEL, JUSTIN (LAC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MANDEL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1309
Mailing Address - Country:US
Mailing Address - Phone:727-606-8700
Mailing Address - Fax:
Practice Address - Street 1:1105 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1309
Practice Address - Country:US
Practice Address - Phone:727-606-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002379-1171100000X
FLAP3562171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist