Provider Demographics
NPI:1548989221
Name:HARRIS, JUVONIA (RDN)
Entity type:Individual
Prefix:MRS
First Name:JUVONIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 WALLINGFORD CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-7007
Mailing Address - Country:US
Mailing Address - Phone:240-416-1591
Mailing Address - Fax:
Practice Address - Street 1:2957 FESTIVAL WAY # 1036
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2959
Practice Address - Country:US
Practice Address - Phone:240-416-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered