Provider Demographics
NPI:1619868676
Name:MANDATO, MADELINE LAROUE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:LAROUE
Last Name:MANDATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 SILVER MOON LN
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-0026
Mailing Address - Country:US
Mailing Address - Phone:407-722-4084
Mailing Address - Fax:
Practice Address - Street 1:6424 ALEXANDRA LOUISE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5810
Practice Address - Country:US
Practice Address - Phone:407-499-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11040753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily