Provider Demographics
NPI:1710779962
Name:HELDORE, TONY
Entity type:Individual
Prefix:MR
First Name:TONY
Middle Name:
Last Name:HELDORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 NW 204TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-2028
Mailing Address - Country:US
Mailing Address - Phone:352-235-9467
Mailing Address - Fax:352-235-9467
Practice Address - Street 1:3061 NW 204TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-2028
Practice Address - Country:US
Practice Address - Phone:352-235-9467
Practice Address - Fax:352-235-9467
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH436-800-70-157-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty