Provider Demographics
NPI:1982438552
Name:MENDONCA, JOLVEEN
Entity type:Individual
Prefix:
First Name:JOLVEEN
Middle Name:
Last Name:MENDONCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 FITNESS CLUB WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5135
Mailing Address - Country:US
Mailing Address - Phone:813-573-6659
Mailing Address - Fax:
Practice Address - Street 1:535 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3620
Practice Address - Country:US
Practice Address - Phone:718-984-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014292225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant