Healthcare Provider Details

I. General information

NPI: 1760394076
Provider Name (Legal Business Name): EMILY RENEE JANOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 SUNTREE BLVD STE 101
ROCKLEDGE FL
32955-5741
US

IV. Provider business mailing address

3190 SUNTREE BLVD STE 101
ROCKLEDGE FL
32955-5741
US

V. Phone/Fax

Practice location:
  • Phone: 347-623-4369
  • Fax: 321-306-2787
Mailing address:
  • Phone: 347-623-4369
  • Fax: 321-306-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: