Healthcare Provider Details

I. General information

NPI: 1689219347
Provider Name (Legal Business Name): RENE ANDRADE MACHADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5158 APPENINE LOOP E
SAINT CLOUD FL
34771-9241
US

IV. Provider business mailing address

5158 APPENINE LOOP E
SAINT CLOUD FL
34771-9241
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3464
  • Fax: 414-266-3466
Mailing address:
  • Phone: 414-266-3464
  • Fax: 414-266-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number76207
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME166788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: