Basic Information
Provider Information
NPI: 1457651317
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RENDE
FirstName: SHARON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: AUD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 863407
Address2:  
City: ORLANDO
State: FL
PostalCode: 328863407
CountryCode: US
TelephoneNumber: 9419172600
FaxNumber: 9419177884
Practice Location
Address1: 1901 FLOYD ST
Address2:  
City: SARASOTA
State: FL
PostalCode: 342392932
CountryCode: US
TelephoneNumber: 9413669222
FaxNumber: 9413652269
Other Information
ProviderEnumerationDate: 10/26/2010
LastUpdateDate: 12/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X000871-01NYN Speech, Language and Hearing Service ProvidersAudiologist 
231H00000XAY2172FLY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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