Healthcare Provider Details

I. General information

NPI: 1467117663
Provider Name (Legal Business Name): RACHEL RENAUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6723 TOWPATH RD
EAST SYRACUSE NY
13057-9506
US

IV. Provider business mailing address

6723 TOWPATH RD
EAST SYRACUSE NY
13057-9506
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-1004
  • Fax:
Mailing address:
  • Phone: 315-425-1004
  • Fax: 315-235-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number032472
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: