Provider Demographics
NPI:1962059840
Name:CORDOVI, JELENY (SA-C)
Entity type:Individual
Prefix:
First Name:JELENY
Middle Name:
Last Name:CORDOVI
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 FAIRLAKE TRCE APT 2301
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2810
Mailing Address - Country:US
Mailing Address - Phone:954-614-1551
Mailing Address - Fax:
Practice Address - Street 1:1109 FAIRLAKE TRCE APT 2301
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2810
Practice Address - Country:US
Practice Address - Phone:954-614-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19-305246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant