Provider Demographics
NPI:1306970892
Name:MILLER, RENEE FLOYD (MED)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:FLOYD
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 MATTHEWS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8847
Mailing Address - Country:US
Mailing Address - Phone:919-796-4701
Mailing Address - Fax:919-873-0959
Practice Address - Street 1:5860 FARINGDON PL
Practice Address - Street 2:SUITE 1
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3931
Practice Address - Country:US
Practice Address - Phone:919-790-3838
Practice Address - Fax:919-873-0959
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411552Medicaid