MEDICARE: DR. RHONDA S PERDUE PH 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	103TC0700X	Clinical Psychologist	PY5257	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K8783	OTHER	FL	GROUP NUMBER

General Provider Information

NPI Number	:	1992861272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RHONDA S PERDUE PH D

Provider Business Mailing Address
First Line	:	10111 W FOREST HILL BLVD
Second Line	:	SUITE 369
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6108
Country	:	US
Telephone Number	:	561-784-7767
Fax Number	:

Provider Business Practice Location Address
First Line	:	10111 W FOREST HILL BLVD
Second Line	:	SUITE 369
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6108
Country	:	US
Telephone Number	:	561-784-7767
Fax Number	:

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	02/08/2008

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