Provider Demographics
NPI:1134578735
Name:RENAUD, COLIN (DC, MS, MSPAS, PA-C)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:
Last Name:RENAUD
Suffix:
Gender:M
Credentials:DC, MS, MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 WESTCHESTER AVE APT 2219
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3524
Mailing Address - Country:US
Mailing Address - Phone:508-612-9618
Mailing Address - Fax:
Practice Address - Street 1:3010 WESTCHESTER AVE STE 404
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2524
Practice Address - Country:US
Practice Address - Phone:914-730-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4660111N00000X
NC0010-09109363A00000X
NY025726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor