Provider Demographics
NPI:1386755734
Name:MENDELSOHN, JAY SHERMAN (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:SHERMAN
Last Name:MENDELSOHN
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 1:3230 STIRLING RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-963-5000
Mailing Address - Fax:954-963-5077
Practice Address - Street 1:3230 STIRLING RD
Practice Address - Street 2:SUITE #3
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-963-5000
Practice Address - Fax:954-963-5077
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040148208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068520800Medicaid
FL94291XMedicare PIN
D63190Medicare UPIN