Provider Demographics
NPI:1104569904
Name:MURPHY, MATTHEW (MPH, RD, LD/N, CPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:MPH, RD, LD/N, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 COLUMBIA DR FL 3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3584
Mailing Address - Country:US
Mailing Address - Phone:813-844-3559
Mailing Address - Fax:
Practice Address - Street 1:39 COLUMBIA DR FL 3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3584
Practice Address - Country:US
Practice Address - Phone:813-844-3559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 133VN1005X
FL10282133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal