Jeffrey D Mandelkorn

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY 8957 Issued in FL

Practice address

2419 E Commercial Blvd Ste 203
Fort Lauderdale, FL 33308-4042

Phone

(954) 380-8980

NPI assigned

Feb 4, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1033532536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2686 NW 95TH TER",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330654943",
            "telephone_number": "954-380-8980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2419 E COMMERCIAL BLVD STE 203",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333084042",
            "telephone_number": "954-380-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDELKORN",
        "first_name": "JEFFREY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-04",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "PY8957",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 8957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janis Manalang, L.P.C. LHMC
• Eli Manata Sloan
• Arnol Miguel Mancera Sanchez, SA-C
• Mayerli Alejandra Mancia, BEHAVIOR TECHNICIAN
• Vanessa Lynn Mancuso, DDS, MSD
• Barbara Mandrisch, OT
• Anele Ramia Manfredini, M.D.
• Stephen James Mangan, DMD
• Monique Lenore Manganelli, MD
• Benson Scott Mangleburg, RPH

• Clinical Psychologist in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.