Provider Demographics
NPI:1932285178
Name:RENIERI, EDA SUSAN (MASTECTOMY FITTER)
Entity Type:Individual
Prefix:MS
First Name:EDA
Middle Name:SUSAN
Last Name:RENIERI
Suffix:
Gender:F
Credentials:MASTECTOMY FITTER
Other - Prefix:MS
Other - First Name:EDA
Other - Middle Name:SUSAN
Other - Last Name:PEITHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:(MASTECTOMY FITTER)
Mailing Address - Street 1:517 EAST STRAWBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-728-9442
Mailing Address - Fax:321-728-9440
Practice Address - Street 1:517 EAST STRAWBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-728-9442
Practice Address - Fax:321-728-9440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
M2733OtherBLUE CROSS BLUE SHIELD FL
FL44539000OtherCIGNA
M2733OtherBLUE CROSS BLUE SHIELD FL