Provider Demographics
NPI:1134324460
Name:GUADAGNO, TRESSY (OTR)
Entity Type:Individual
Prefix:
First Name:TRESSY
Middle Name:
Last Name:GUADAGNO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14302 SW 125TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6091
Mailing Address - Country:US
Mailing Address - Phone:305-251-6093
Mailing Address - Fax:
Practice Address - Street 1:14302 SW 125TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6091
Practice Address - Country:US
Practice Address - Phone:305-251-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9812174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty