Provider Demographics
NPI:1386261741
Name:FEDORKO, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:FEDORKO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 N FEDERAL HWY STE 100A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1659
Mailing Address - Country:US
Mailing Address - Phone:561-823-1030
Mailing Address - Fax:
Practice Address - Street 1:7601 N FEDERAL HWY STE 100A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1659
Practice Address - Country:US
Practice Address - Phone:561-823-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007840363L00000X
FL11007840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner