Healthcare Provider Details

I. General information

NPI: 1487013058
Provider Name (Legal Business Name): ROBERT HENDLEY M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 36TH ST STE 1C
VERO BEACH FL
32960-4898
US

IV. Provider business mailing address

550 9TH ST SW
VERO BEACH FL
32962-4711
US

V. Phone/Fax

Practice location:
  • Phone: 772-770-4911
  • Fax:
Mailing address:
  • Phone: 772-770-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0049021
License Number StateFL

VIII. Authorized Official

Name: ROBRIELLE HENDLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 772-770-4911