Provider Demographics
NPI:1245223080
Name:ROODNARINE, DEANNE S (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:S
Last Name:ROODNARINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 SW 71ST WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7150
Mailing Address - Country:US
Mailing Address - Phone:954-476-3646
Mailing Address - Fax:954-476-3646
Practice Address - Street 1:2112 SW 71ST WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7150
Practice Address - Country:US
Practice Address - Phone:954-476-3646
Practice Address - Fax:954-476-3646
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2177213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U20138Medicare UPIN
FL65173Medicare ID - Type Unspecified