Provider Demographics
NPI:1386603108
Name:SHER, MANDEL R (MD)
Entity type:Individual
Prefix:
First Name:MANDEL
Middle Name:R
Last Name:SHER
Suffix:
Gender:M
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:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:
Practice Address - Street 1:11200 SEMINOLE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778
Practice Address - Country:US
Practice Address - Phone:727-397-8557
Practice Address - Fax:727-397-4459
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44364207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042758601Medicaid
FL79853OtherBLUE CROSS BLUE SHIELD
FL79853Medicare PIN
FL79853OtherBLUE CROSS BLUE SHIELD