Provider Demographics
NPI:1538056635
Name:MENDELLA, GINA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MENDELLA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SE 2ND ST APT 1218
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-4183
Mailing Address - Country:US
Mailing Address - Phone:954-789-1694
Mailing Address - Fax:
Practice Address - Street 1:220 SE 2ND ST APT 1218
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-4183
Practice Address - Country:US
Practice Address - Phone:954-789-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA22919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist