Healthcare Provider Details

I. General information

NPI: 1275844482
Provider Name (Legal Business Name): DEBORAH LYNN RENELUS-MARSHALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S MARTIN LUTHER KING JR AVE
CLEARWATER FL
33756-4172
US

IV. Provider business mailing address

14100 58TH ST N
CLEARWATER FL
33760-9900
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax:
Mailing address:
  • Phone: 727-824-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME124988
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME124988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: