Provider Demographics
NPI:1881171189
Name:MONDI, ALEXANDRA (LPN)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MONDI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-4223
Mailing Address - Country:US
Mailing Address - Phone:631-365-3136
Mailing Address - Fax:
Practice Address - Street 1:97 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-4223
Practice Address - Country:US
Practice Address - Phone:631-365-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330240164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse