Healthcare Provider Details

I. General information

NPI: 1427914266
Provider Name (Legal Business Name): ASHLEY RUDNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 SW 104TH ST
PINECREST FL
33156-3149
US

IV. Provider business mailing address

15095 SW 113TH TER
MIAMI FL
33196-4306
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-7546
  • Fax:
Mailing address:
  • Phone: 786-369-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number9654365
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: