Healthcare Provider Details

I. General information

NPI: 1386835973
Provider Name (Legal Business Name): DOREEN RODO R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5317 4TH AVE CIRCLE EAST
BRADENTON FL
34208-5623
US

IV. Provider business mailing address

PO BOX 637801 ATT: IPM CREDENTIALING
CINCINNATI OH
45263-7801
US

V. Phone/Fax

Practice location:
  • Phone: 941-254-4957
  • Fax: 941-254-4958
Mailing address:
  • Phone: 775-356-9393
  • Fax: 775-356-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000721
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: