Provider Demographics
NPI:1073353686
Name:GRAHAM, RACHAEL (RDN, LDN)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34903 CUTOFF RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-3028
Mailing Address - Country:US
Mailing Address - Phone:352-552-3826
Mailing Address - Fax:
Practice Address - Street 1:34903 CUTOFF RD
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-3028
Practice Address - Country:US
Practice Address - Phone:352-552-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12702133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered