MEDICARE: DOREEN RODO R.D.

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	133V00000X	Registered Dietitian	000721	CT
2	133V00000X	Registered Dietitian	ND7523	FL

General Provider Information

NPI Number	:	1386835973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOREEN RODO R.D.

Provider Business Mailing Address
First Line	:	PO BOX 637801
Second Line	:	ATT: IPM CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45263-7801
Country	:	US
Telephone Number	:	775-356-9393
Fax Number	:	775-356-5590

Provider Business Practice Location Address
First Line	:	5317 4TH AVE CIRCLE EAST
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-5623
Country	:	US
Telephone Number	:	941-254-4957
Fax Number	:	941-254-4958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	03/31/2016

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