Healthcare Provider Details

I. General information

NPI: 1750096673
Provider Name (Legal Business Name): DANIEL MENDES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12309 PEMBROKE RD
PEMBROKE PINES FL
33025-1723
US

IV. Provider business mailing address

6719 NW 81ST CT
PARKLAND FL
33067-2496
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-6595
  • Fax:
Mailing address:
  • Phone: 954-263-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: