Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD.203226 | LA |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | ME144091 | FL |
N | 207RC0000X | Internist - Cardiovascular Disease | 2006015684 | MO |
N | 207RC0000X | Internist - Cardiovascular Disease | MD.203226 | LA |
NPI | 1407069818 |
---|---|
Provider Name | Stacy Allison Mandras |
First Address | Orlando, FL 32804-5521 |
Second Address | Orlando, FL 32804-5521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07720531 | (05) | MS |
1889938 | (05) | LA |
2006015684 | LICENSE NUMBER (01) | MO |