Provider Demographics
NPI:1720840796
Name:STCLOUD, MARIE KENANDE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:KENANDE
Last Name:STCLOUD
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 1:8710 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6508
Mailing Address - Country:US
Mailing Address - Phone:754-217-0825
Mailing Address - Fax:
Practice Address - Street 1:1319 BUCHANAN ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4446
Practice Address - Country:US
Practice Address - Phone:240-636-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health