MEDICARE: SANDY RODRIGUEZ CORREA

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	101YM0800X	Mental Health Counselor	MH2593	FL

General Provider Information

NPI Number	:	1689358988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDY RODRIGUEZ CORREA

Provider Business Mailing Address
First Line	:	DEPT 394 PO BOX 1000
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	941-300-4440
Fax Number	:	941-404-1760

Provider Business Practice Location Address
First Line	:	3012 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4356
Country	:	US
Telephone Number	:	954-776-9992
Fax Number	:	954-776-9993

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

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	04/16/2026

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