Healthcare Provider Details

I. General information

NPI: 1124416003
Provider Name (Legal Business Name): REBECCA MANDEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 SHERIDAN ST STE 101
HOLLYWOOD FL
33021-3567
US

IV. Provider business mailing address

4340 SHERIDAN ST STE 101
HOLLYWOOD FL
33021-3567
US

V. Phone/Fax

Practice location:
  • Phone: 954-983-5533
  • Fax:
Mailing address:
  • Phone: 954-983-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: