Healthcare Provider Details

I. General information

NPI: 1184867202
Provider Name (Legal Business Name): JEANNE-ELYSE GRAY CEDENO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JEANNE ELYSE GRAY

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10041 PINES BLVD STE A
PEMBROKE PINES FL
33024-6170
US

IV. Provider business mailing address

5010 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6557
US

V. Phone/Fax

Practice location:
  • Phone: 754-273-6278
  • Fax: 954-374-6954
Mailing address:
  • Phone: 954-266-2999
  • Fax: 954-966-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME106978
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10030078
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: