Provider Demographics
NPI:1477126845
Name:AMEDEO, MICHAEL W (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:AMEDEO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 PLUMLEE CT
Mailing Address - Street 2:N/A
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9013
Mailing Address - Country:US
Mailing Address - Phone:352-636-6485
Mailing Address - Fax:
Practice Address - Street 1:3253 PLUMLEE CT
Practice Address - Street 2:N/A
Practice Address - City:GRAND ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32735-9013
Practice Address - Country:US
Practice Address - Phone:352-636-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9377895163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency