Provider Demographics
NPI:1083602544
Name:MENDOZA, JENNIFER H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MENDOZA
Other - Last Name:SAYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5815 FRENCH CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-5205
Mailing Address - Country:US
Mailing Address - Phone:941-721-6325
Mailing Address - Fax:941-723-6741
Practice Address - Street 1:323 10TH AVE W
Practice Address - Street 2:SUITE 302
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5047
Practice Address - Country:US
Practice Address - Phone:941-721-6325
Practice Address - Fax:941-723-6741
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54125Medicare ID - Type Unspecified