Provider Demographics
NPI:1386979870
Name:DELEON, SHIRLEY (RD/LD)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:DELEON
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 COMMERCE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3943
Mailing Address - Country:US
Mailing Address - Phone:305-816-5800
Mailing Address - Fax:305-816-5844
Practice Address - Street 1:3114 COMMERCE PARKWAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3943
Practice Address - Country:US
Practice Address - Phone:305-816-5800
Practice Address - Fax:305-816-5844
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered