Individual
MR. MICHAEL D. BEREDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(570) 887-4464
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
538854-1
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
RN542206
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430078581
RR MEDICARE PIN
PA
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039832
MEDICARE GROUP
PA
01
—
P00379063
RR MEDICARE PIN
NY
Enumeration date
03/14/2006
Last updated
06/22/2011
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