Healthcare Provider Details

I. General information

NPI: 1942129457
Provider Name (Legal Business Name): KENNEDY RENE MCCOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S LAKE DESTINY RD STE 350
MAITLAND FL
32751-7222
US

IV. Provider business mailing address

4064 CASTLEGATE DR
ORLANDO FL
32839-3201
US

V. Phone/Fax

Practice location:
  • Phone: 407-764-7655
  • Fax:
Mailing address:
  • Phone: 407-640-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-543535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: