Provider Demographics
NPI:1629364583
Name:MENDELSON, REINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:REINA
Middle Name:
Last Name:MENDELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REINA
Other - Middle Name:
Other - Last Name:EISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8188 S JOG RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2952
Mailing Address - Country:US
Mailing Address - Phone:305-401-6341
Mailing Address - Fax:
Practice Address - Street 1:8188 S JOG RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2952
Practice Address - Country:US
Practice Address - Phone:305-401-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336575363LF0000X
FL9347305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily