Provider Demographics
NPI:1881554277
Name:DAGOLD, MANDY
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:DAGOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31688 SUN KETTLE LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-2345
Mailing Address - Country:US
Mailing Address - Phone:240-671-5533
Mailing Address - Fax:
Practice Address - Street 1:31688 SUN KETTLE LOOP
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-2345
Practice Address - Country:US
Practice Address - Phone:240-671-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL240909253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care