Provider Demographics
NPI:1467825109
Name:MANDLER, ALYSSA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:MANDLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 SW 1ST AVE
Mailing Address - Street 2:APT 2814
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3420
Mailing Address - Country:US
Mailing Address - Phone:305-972-3484
Mailing Address - Fax:
Practice Address - Street 1:3200 SW 60TH CT
Practice Address - Street 2:SUITE 302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-662-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9108937363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical