Provider Demographics
NPI:1437154218
Name:RDZANEK, IRENA RENATA
Entity Type:Individual
Prefix:
First Name:IRENA
Middle Name:RENATA
Last Name:RDZANEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ESTRELLITA DR
Mailing Address - Street 2:
Mailing Address - City:FT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-5204
Mailing Address - Country:US
Mailing Address - Phone:239-463-7149
Mailing Address - Fax:239-463-7149
Practice Address - Street 1:5600 TRAIL BLVD
Practice Address - Street 2:STE 16
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2860
Practice Address - Country:US
Practice Address - Phone:239-566-2727
Practice Address - Fax:239-463-7149
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY77237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ0594OtherBLUE CROSS BLUE SHIELD
FLS0792OtherBLUE CROSS BLUE SHIELD