Provider Demographics
NPI:1316231509
Name:KAGANAS, SIMA (RD)
Entity type:Individual
Prefix:
First Name:SIMA
Middle Name:
Last Name:KAGANAS
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 1:1045 NE 179TH TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1256
Mailing Address - Country:US
Mailing Address - Phone:305-213-2009
Mailing Address - Fax:
Practice Address - Street 1:1130 NE 178TH TER
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1275
Practice Address - Country:US
Practice Address - Phone:305-213-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered