Provider Demographics
NPI:1659763779
Name:REDIO RONDON, SONIA (APRN)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:REDIO RONDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-4312
Mailing Address - Country:US
Mailing Address - Phone:772-257-8224
Mailing Address - Fax:772-213-3157
Practice Address - Street 1:12196 COUNTY ROAD 512
Practice Address - Street 2:
Practice Address - City:FELLSMERE
Practice Address - State:FL
Practice Address - Zip Code:32948-5463
Practice Address - Country:US
Practice Address - Phone:772-257-8224
Practice Address - Fax:772-213-3157
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130466363LA2200X, 363LP0808X
FLAPRN11010591101YM0800X
FL11010591363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110501900Medicaid