Provider Demographics
NPI:1831449438
Name:VENDRYS, REGINE
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:VENDRYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 SW 123RD CT
Mailing Address - Street 2:APT. #207
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7191
Mailing Address - Country:US
Mailing Address - Phone:786-326-9280
Mailing Address - Fax:
Practice Address - Street 1:9280 SW 123RD CT
Practice Address - Street 2:APT. 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7191
Practice Address - Country:US
Practice Address - Phone:786-326-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health