Provider Demographics
NPI:1912460130
Name:TENDRICH, TAYLOR RAE (DPM)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE
Last Name:TENDRICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD STE 4102
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7190
Mailing Address - Country:US
Mailing Address - Phone:561-626-3338
Mailing Address - Fax:561-776-5100
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 4102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7190
Practice Address - Country:US
Practice Address - Phone:561-626-3338
Practice Address - Fax:561-776-5100
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4248213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist