Healthcare Provider Details

I. General information

NPI: 1669383071
Provider Name (Legal Business Name): RODDERICK GAINEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 HARRIS HAWK AVE
RUSKIN FL
33570-4967
US

IV. Provider business mailing address

2327 HARRIS HAWK AVE
RUSKIN FL
33570-4967
US

V. Phone/Fax

Practice location:
  • Phone: 813-834-5907
  • Fax:
Mailing address:
  • Phone: 813-834-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: