Provider Demographics
NPI:1386740819
Name:MATTHEWS, RENEE B (MS, RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:B
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 LEGACY PARK DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2404
Mailing Address - Country:US
Mailing Address - Phone:407-790-1327
Mailing Address - Fax:
Practice Address - Street 1:728 LEGACY PARK DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-2404
Practice Address - Country:US
Practice Address - Phone:407-790-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
811854133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered