Provider Demographics
NPI:1699263939
Name:FLOYD, DONETTA (RD, LDN)
Entity type:Individual
Prefix:
First Name:DONETTA
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WENDOVER AVE STE 415
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1211
Mailing Address - Country:US
Mailing Address - Phone:336-832-3236
Mailing Address - Fax:336-832-3240
Practice Address - Street 1:301 E WENDOVER AVE STE 415
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1211
Practice Address - Country:US
Practice Address - Phone:336-832-3236
Practice Address - Fax:336-832-3240
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005384133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered