Provider Demographics
NPI:1477424919
Name:SAUNDERSON, JONATHAN MARSHALL
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARSHALL
Last Name:SAUNDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SW 15TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3920
Mailing Address - Country:US
Mailing Address - Phone:954-529-0186
Mailing Address - Fax:
Practice Address - Street 1:330 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2051
Practice Address - Country:US
Practice Address - Phone:954-791-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit