| Doctor Name: | SHASTA MANDAN |
| NPI Number: | 1386092203 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N., C.D.E. |
| License Number: | R29464 |
| Business Practice Address: | 1058 College Dr New Town, ND - 587639112 |
| Business Phone Number: | 7016277931 |
| Business Fax Number: | |
| Mailing Address: | 1058 College Dr, NEW TOWN |
| State: | ND |
| Postal Code: | 587639112 |
| Phone Number: | 7016277931 |
| Fax Number: | |
| NPI Enumeration Date: | 06/01/2016 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | R29464 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |