Provider Demographics
NPI:1124416003
Name:MANDEL, REBECCA (PA)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:MANDEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 N FEDERAL HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1400
Mailing Address - Country:US
Mailing Address - Phone:954-500-7546
Mailing Address - Fax:
Practice Address - Street 1:6550 N FEDERAL HWY STE 320
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1400
Practice Address - Country:US
Practice Address - Phone:954-500-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018210363A00000X
FLPA9113620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant