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General NPI Number Information
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NPI Number | 1356141774
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Entity Type | Individual
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Provider Name | MEREDITH TRACEY RENODO
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Gender | Female
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 16855 NE 2ND AVE STE 102
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-1744
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Country | US
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Telephone | 786-914-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 13499 BISCAYNE BLVD
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2043
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Country | US
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Telephone | 786-914-8860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002220-PA
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License Number State | PR
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