Provider Demographics
NPI:1588991590
Name:BELLEVUE-EUSEBE, JESSIE (LD/N)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:
Last Name:BELLEVUE-EUSEBE
Suffix:
Gender:F
Credentials:LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 COMMERCE PKWY
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 1:3102 COMMERCE PKWY
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:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2912133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered