Provider Demographics
NPI:1255606992
Name:FENELON, JEAN RENAUD (RRT)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:RENAUD
Last Name:FENELON
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 NW 210TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-7003
Mailing Address - Country:US
Mailing Address - Phone:786-263-8355
Mailing Address - Fax:
Practice Address - Street 1:880 NW 210TH ST APT 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-7003
Practice Address - Country:US
Practice Address - Phone:786-263-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT 115792279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care