Provider Demographics
NPI:1871718437
Name:MENDELSOHN, PAULA HARRISA (MPH, RD, LD, CCN)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:HARRISA
Last Name:MENDELSOHN
Suffix:
Gender:F
Credentials:MPH, RD, LD, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE SPANISH RIVER BLVD
Mailing Address - Street 2:STE 105-B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4515
Mailing Address - Country:US
Mailing Address - Phone:561-394-8490
Mailing Address - Fax:561-394-9846
Practice Address - Street 1:500 NE SPANISH RIVER BLVD
Practice Address - Street 2:STE 105-B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4515
Practice Address - Country:US
Practice Address - Phone:561-394-8490
Practice Address - Fax:561-394-9846
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 695133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNO117OtherBLUE CROSS BLUE SHIELD
FL01-90261OtherUNITED HEALTH CARE