Provider Demographics
NPI:1104346840
Name:WEISSMAN, JESSICA (PHD, RD, LDN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 JOSLIN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6400
Mailing Address - Country:US
Mailing Address - Phone:954-483-9070
Mailing Address - Fax:
Practice Address - Street 1:3571 JOSLIN WAY
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6400
Practice Address - Country:US
Practice Address - Phone:954-483-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1033616133V00000X
FLND5985133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered