Provider Demographics
NPI:1659837284
Name:RODDY, MERCEDES SHIRNEE
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:SHIRNEE
Last Name:RODDY
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 1:1325 WELCH RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4900
Mailing Address - Country:US
Mailing Address - Phone:321-945-3466
Mailing Address - Fax:
Practice Address - Street 1:1325 WELCH RIDGE TER
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-4900
Practice Address - Country:US
Practice Address - Phone:321-945-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL190683374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty