Provider Demographics
NPI:1053028415
Name:MEDICAL DIETITIANS LLC
Entity type:Organization
Organization Name:MEDICAL DIETITIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:OF
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH RD LDN CDCES
Authorized Official - Phone:813-460-8792
Mailing Address - Street 1:229 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-2524
Mailing Address - Country:US
Mailing Address - Phone:813-460-8792
Mailing Address - Fax:
Practice Address - Street 1:229 45TH AVE
Practice Address - Street 2:
Practice Address - City:ST PETE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33706-2524
Practice Address - Country:US
Practice Address - Phone:181-346-0879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty