Provider Demographics
NPI:1386609329
Name:LANDY, JENNIFER SARA (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SARA
Last Name:LANDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:540 MEDICAL OAKS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5995
Mailing Address - Country:US
Mailing Address - Phone:813-684-2211
Mailing Address - Fax:813-655-7669
Practice Address - Street 1:540 MEDICAL OAKS AVE STE 103
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5995
Practice Address - Country:US
Practice Address - Phone:813-684-2211
Practice Address - Fax:813-685-0895
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89152207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273089800Medicaid
FL273089800Medicaid
FLME89152OtherLICENSE NO
FLU3331RMedicare PIN
FLI16603Medicare UPIN
FL273089800Medicaid
FLU3331TMedicare PIN