Individual
MS. EDA SUSAN RENIERI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASTECTOMY FITTER
Contact information
Practice address
517 EAST STRAWBRIDGE AVE, MELBOURNE, FL 32901
(321) 728-9442
(321) 728-9440
Mailing address
517 EAST STRAWBRIDGE AVE, MELBOURNE, FL 32901
(321) 728-9442
(321) 728-9440
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
—
—
225000000X
Orthotic Fitter
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44539000
CIGNA
FL
01
—
M2733
BLUE CROSS BLUE SHIELD FL
—
Enumeration date
10/31/2006
Last updated
02/24/2020
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