Provider Demographics
NPI:1497100788
Name:RODRIGUEZ, SUINDA ENID I
Entity Type:Individual
Prefix:
First Name:SUINDA
Middle Name:ENID
Last Name:RODRIGUEZ
Suffix:I
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 1:2118 FLORIDA SOAPBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4869
Mailing Address - Country:US
Mailing Address - Phone:407-493-9217
Mailing Address - Fax:
Practice Address - Street 1:2118 FLORIDA SOAPBERRY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4869
Practice Address - Country:US
Practice Address - Phone:407-493-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation