Provider Demographics
NPI:1013400373
Name:MENDEZ-CORDERO, GISEL IVETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GISEL
Middle Name:IVETTE
Last Name:MENDEZ-CORDERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-8240
Mailing Address - Fax:239-468-7906
Practice Address - Street 1:5225 CLAYTON CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2117
Practice Address - Country:US
Practice Address - Phone:239-343-8240
Practice Address - Fax:239-468-7906
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11300103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116188200Medicaid