Provider Demographics
NPI:1497270243
Name:JEGEDE, SOONDY RENAE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SOONDY
Middle Name:RENAE
Last Name:JEGEDE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SOONDY
Other - Middle Name:RENAE
Other - Last Name:JEGEDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3 RIVER ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4957
Mailing Address - Country:US
Mailing Address - Phone:386-235-0348
Mailing Address - Fax:
Practice Address - Street 1:3 RIVER ROCK TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4957
Practice Address - Country:US
Practice Address - Phone:386-235-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009986363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health