Healthcare Provider Details

I. General information

NPI: 1508169962
Provider Name (Legal Business Name): SOUTH FLORIDA SINUS AND ALLERGY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SHERIDAN ST
HOLLYWOOD FL
33021-3514
US

IV. Provider business mailing address

4400 SHERIDAN ST
HOLLYWOOD FL
33021-3514
US

V. Phone/Fax

Practice location:
  • Phone: 954-983-1211
  • Fax: 954-983-4190
Mailing address:
  • Phone: 954-983-1211
  • Fax: 954-983-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME67643
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberME67643
License Number StateFL

VIII. Authorized Official

Name: DR. LEE M. MANDEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-983-1211