Healthcare Provider Details

I. General information

NPI: 1194390039
Provider Name (Legal Business Name): RONI RACHEL MENDELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date: 11/14/2022
Reactivation Date: 02/13/2023

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3300
  • Fax:
Mailing address:
  • Phone: 901-595-3300
  • Fax: 202-687-8935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116035335
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMTL200001326
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: