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NPI Code Detail

MEDICARE: PHYLLIS MCCLENDON

MEDICARE: PHYLLIS MCCLENDON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1376235515
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS MCCLENDON
Provider Business Mailing Address
First Line : 2254 SAW PALMETTO LN APT 104
Second Line :
City : ORLANDO
State : FL
Zip : 32828-4651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2254 SAW PALMETTO LN APT 104
Second Line :
City : ORLANDO
State : FL
Zip : 32828-4651
Country : US
Telephone Number : 904-554-2007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2023
Last Update Date : 05/25/2023

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Directions to “ PHYLLIS MCCLENDON ” Practice Location

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