Provider Demographics
NPI:1952715682
Name:MONDESIR, CLAUDENIE (PA)
Entity Type:Individual
Prefix:MS
First Name:CLAUDENIE
Middle Name:
Last Name:MONDESIR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4857 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-7218
Mailing Address - Country:US
Mailing Address - Phone:954-560-7124
Mailing Address - Fax:
Practice Address - Street 1:4857 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-7218
Practice Address - Country:US
Practice Address - Phone:954-560-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant