Perry Nicholas Mandanis, M.D.
Individual provider Active NPI Child & Adolescent Psychiatry Physician · Hampton, CT
NPI 1104043249 · NPPES record last updated Nov 14, 2012
Key facts
- NPI
- 1104043249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child & Adolescent Psychiatry Physician 2084P0804X
- License
- 042739 (CT)
- Practice address
- 189 N Bigelow Rd
Hampton, CT 06247-1408 - Phone
- (860) 455-1119
- NPI assigned
- Apr 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042739 | CT | MD | Child & Adolescent Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 042739 | CT | Yes |
Addresses
Primary practice location
189 N Bigelow Rd
Hampton, CT 06247-1408
Mailing address
189 N Bigelow Rd
Hampton, CT 06247-1408
Phone (860) 455-1119
Other providers in Hampton, CT
- Julia Garrick
- Hampton School District
- Hampton-Chaplin Ambulance Corps Inc
- Leon McTyeire Johnston III
- James H Krall
- Antonia Brancia Maxon
- Paul Nash
- New England Center for Hearing
- New England Center for Hearing Rehabilitation
- Emily Potrzeba
All providers in Hampton, CT · Child & Adolescent Psychiatry Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.