Provider Demographics
NPI:1699206623
Name:HIGHSTEIN, MALLORY JAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:JAYNE
Last Name:HIGHSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W WOOLBRIGHT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6398
Mailing Address - Country:US
Mailing Address - Phone:561-990-4128
Mailing Address - Fax:
Practice Address - Street 1:1800 W WOOLBRIGHT RD STE 201
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6398
Practice Address - Country:US
Practice Address - Phone:561-990-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME157711207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program