Provider Demographics
NPI:1528163417
Name:DENYA, CONSTANCE ELLEN (RD)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:ELLEN
Last Name:DENYA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 SW WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4946
Mailing Address - Country:US
Mailing Address - Phone:772-878-0620
Mailing Address - Fax:
Practice Address - Street 1:714 AVENUE C
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4189
Practice Address - Country:US
Practice Address - Phone:772-462-3900
Practice Address - Fax:772-462-3869
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND553133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered