Provider Demographics
NPI:1518241645
Name:MALANDRO, JAMES SYLVESTER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SYLVESTER
Last Name:MALANDRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 N 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3309
Mailing Address - Country:US
Mailing Address - Phone:954-962-9740
Mailing Address - Fax:954-962-9740
Practice Address - Street 1:2140 N 52ND AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3309
Practice Address - Country:US
Practice Address - Phone:954-962-9740
Practice Address - Fax:954-962-9740
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038560300Medicaid
FL93701ZMedicare PIN