| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JORDAN HANDO | 1205430162 | 2020-11-22 |
| Entity Type | Individual |
| Provider Name | Jordan Hando |
| Practice Office Address | 3662 TIMBER LN HERMITAGE, PA US |
| Practice Office Telephone | 7249772215 |
| Mailing Address | 3662 TIMBER LN HERMITAGE, PA 161486026 US |
| Code | License No | State |
|---|---|---|
| 2255A2300X | ||
| 390200000X PRIMARY |