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NPI Code Detail

MEDICARE: KREDO HEALTH LLC

MEDICARE: KREDO HEALTH LLC
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
12081P0010XPediatric Rehabilitation Medicine Physician
2225X00000XOccupational Therapist
3235Z00000XSpeech-Language Pathologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427796630
Entity Type Code : Organization
Provider Name (Legal Business Name) : KREDO HEALTH LLC
Provider Business Mailing Address
First Line : 1939 MAGUIRE RD STE 107-108
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-7942
Country : US
Telephone Number : 407-619-8156
Fax Number :
Provider Business Practice Location Address
First Line : 1939 MAGUIRE RD STE 107-108
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-7942
Country : US
Telephone Number : 407-473-8005
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : MRS. SOAUD CORNELL
Credential :
Telephone Number : 407-619-8156
Provider Enumeration Date : 05/26/2022
Last Update Date : 10/24/2022

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Directions to “KREDO HEALTH LLC ” Practice Location

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