Provider Demographics
NPI:1700602869
Name:MANDANI, FARAH (CPNP-PC)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:MANDANI
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 NW 47TH WAY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2730
Mailing Address - Country:US
Mailing Address - Phone:407-490-8785
Mailing Address - Fax:
Practice Address - Street 1:7145 NW 47TH WAY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2730
Practice Address - Country:US
Practice Address - Phone:407-490-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036589363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics