Provider Demographics
NPI:1174492862
Name:FUNDORA, JAYMESON DANIEL (APC)
Entity type:Individual
Prefix:
First Name:JAYMESON
Middle Name:DANIEL
Last Name:FUNDORA
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 VILLAS OF GARRARD DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2793
Mailing Address - Country:US
Mailing Address - Phone:813-557-2823
Mailing Address - Fax:
Practice Address - Street 1:32 VILLAS OF GARRARD DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2793
Practice Address - Country:US
Practice Address - Phone:813-557-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health