Provider Demographics
NPI:1841451390
Name:MENDOZA, SUNY (MA)
Entity type:Individual
Prefix:
First Name:SUNY
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7199
Mailing Address - Country:US
Mailing Address - Phone:561-416-2529
Mailing Address - Fax:516-416-1768
Practice Address - Street 1:6018 SW 18TH ST STE C11
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7166
Practice Address - Country:US
Practice Address - Phone:561-416-2529
Practice Address - Fax:516-416-1768
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43789225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist