Provider Demographics
NPI:1811334410
Name:TABORA, JANELL LYNN (MD)
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:LYNN
Last Name:TABORA
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 1:6801 LAKE WORTH RD STE 213-214
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2955
Mailing Address - Country:US
Mailing Address - Phone:561-444-2351
Mailing Address - Fax:561-469-7089
Practice Address - Street 1:6801 LAKE WORTH RD STE 213-214
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2955
Practice Address - Country:US
Practice Address - Phone:561-444-2351
Practice Address - Fax:561-469-7089
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3361019522084P0800X
FL1374822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107183900Medicaid