Provider Demographics
NPI:1861125767
Name:MANDELIA, RUJUTA (MED)
Entity type:Individual
Prefix:
First Name:RUJUTA
Middle Name:
Last Name:MANDELIA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LYNNE CIR
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1026
Mailing Address - Country:US
Mailing Address - Phone:610-636-7006
Mailing Address - Fax:
Practice Address - Street 1:150 S WARNER RD STE 130
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2826
Practice Address - Country:US
Practice Address - Phone:610-938-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health