Provider Demographics
NPI:1386835973
Name:RODO, DOREEN (RD)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:RODO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637801
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7801
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:5317 4TH AVE CIRCLE EAST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5623
Practice Address - Country:US
Practice Address - Phone:941-254-4957
Practice Address - Fax:941-254-4958
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000721133V00000X
FLND7523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare PIN