Healthcare Provider Details

I. General information

NPI: 1659086585
Provider Name (Legal Business Name): SYNERGY MEDICAL COLLECTIVE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 75TH AVE
MIAMI FL
33155-2805
US

IV. Provider business mailing address

PO BOX 749063
ATLANTA GA
30374-9063
US

V. Phone/Fax

Practice location:
  • Phone: 305-264-5252
  • Fax:
Mailing address:
  • Phone: 919-599-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT RODDY
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 919-599-4089