Provider Demographics
NPI:1932100237
Name:MAHONEY, JONELL YOUNG (MD)
Entity Type:Individual
Prefix:MRS
First Name:JONELL
Middle Name:YOUNG
Last Name:MAHONEY
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 1:12983 SOUTHERN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9254
Mailing Address - Country:US
Mailing Address - Phone:561-793-2500
Mailing Address - Fax:561-793-2510
Practice Address - Street 1:12983 SOUTHERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9254
Practice Address - Country:US
Practice Address - Phone:561-793-2500
Practice Address - Fax:561-793-2510
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0060657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372363100Medicaid
FL372363100Medicaid