MEDICARE: RENEE HANEY MD PA

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
1	2084P0802X	Addiction Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1376858266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEE HANEY MD PA

Provider Business Mailing Address
First Line	:	718 W MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 100A
City	:	TAMPA
State	:	FL
Zip	:	33603-3135
Country	:	US
Telephone Number	:	813-224-0355
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 W MARTIN LUTHER KING JR BLVD
Second Line	:	SUITE 100A
City	:	TAMPA
State	:	FL
Zip	:	33603-3135
Country	:	US
Telephone Number	:	813-224-0355
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RENEE HANEY
Credential	:	MD
Telephone Number	:	813-224-0355

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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