Provider Demographics
NPI:1427822105
Name:THERAN, MARTHA C (RDN/LDN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:THERAN
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 TIMBER COVE LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2131
Mailing Address - Country:US
Mailing Address - Phone:954-274-0574
Mailing Address - Fax:
Practice Address - Street 1:5451 N. UNIVERSITY DRIVE, SUITE 103
Practice Address - Street 2:5451 N. UNIVERSITY DRIVE, SUITE 103
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3333
Practice Address - Country:US
Practice Address - Phone:954-274-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86109465133V00000X
FLND12618133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist