Provider Demographics
NPI:1427796937
Name:PERSAK, EVE M (MS RDN CNSC CSSD)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:M
Last Name:PERSAK
Suffix:
Gender:F
Credentials:MS RDN CNSC CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 GULF BLVD UNIT 11E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2809
Mailing Address - Country:US
Mailing Address - Phone:310-713-3425
Mailing Address - Fax:
Practice Address - Street 1:1340 GULF BLVD UNIT 11E
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:FL
Practice Address - Zip Code:33767-2809
Practice Address - Country:US
Practice Address - Phone:310-713-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008230133V00000X
FL9953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered