Randall-Mantella, Susan M
Randall-Mantella, Susan M is an individual health care provider with primary practice located at 4117 Medical Center Dr Pod C, Fayetteville NY 13066-6600. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Randall-Mantella, Susan M can be contacted via phone (315) 329-4975.Contact Information
Primary practice address
4117 Medical Center Dr Pod C
Fayetteville NY 13066-6600
Phone: (315) 329-4975
Fax: (315) 329-4970
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | F330714 | New York |
Profile Details
| NPI number | 1457314650 |
|---|---|
| LBN Legal business name | Randall-Mantella, Susan M |
| Credentials | RNNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 10th, 2006 |
| Last updated | Nov 23rd, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457314650 | NPPES |
| New York | MEDICAID | 02245370 |
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