Provider Demographics
NPI:1194892349
Name:CLEARY, MICHELE B (RD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:B
Last Name:CLEARY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 PADDOCK CIR
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-2425
Mailing Address - Country:US
Mailing Address - Phone:727-786-1521
Mailing Address - Fax:727-789-1930
Practice Address - Street 1:2102 PADDOCK CIR
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-2425
Practice Address - Country:US
Practice Address - Phone:727-786-1521
Practice Address - Fax:727-789-1930
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered