Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 22881 | CT |
NPI | 1134292881 |
---|---|
Provider Name | Silvio Alexander Mandara |
First Address | Stamford, CT 06905-5342 |
Second Address | Stamford, CT 06905-5342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/01/2008 |