Provider Demographics
NPI:1841806684
Name:MEDLY LLC
Entity Type:Organization
Organization Name:MEDLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENNDA
Authorized Official - Middle Name:KAIA
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-304-0379
Mailing Address - Street 1:1305 MORGAN STANLEY AVE UNIT 335
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1961
Mailing Address - Country:US
Mailing Address - Phone:407-476-4260
Mailing Address - Fax:855-746-1576
Practice Address - Street 1:1305 MORGAN STANLEY AVE UNIT 335
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1961
Practice Address - Country:US
Practice Address - Phone:407-476-4260
Practice Address - Fax:855-746-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies