Provider Demographics
NPI:1346631561
Name:FLORIDA INSTITUTE OF NUTRITION AND DIETETICS, INC
Entity type:Organization
Organization Name:FLORIDA INSTITUTE OF NUTRITION AND DIETETICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPRASKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-932-9155
Mailing Address - Street 1:2627 NE 203RD ST STE 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1945
Mailing Address - Country:US
Mailing Address - Phone:305-932-9155
Mailing Address - Fax:305-932-3989
Practice Address - Street 1:2627 NE 203RD ST STE 113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1945
Practice Address - Country:US
Practice Address - Phone:305-932-9155
Practice Address - Fax:305-932-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801000229OtherNPPES
FL1578952040OtherNPPES