MEDICARE: GERMAINE GUY MS, RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND9496	FL

General Provider Information

NPI Number	:	1578179628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERMAINE GUY MS, RDN, LDN

Provider Business Mailing Address
First Line	:	23482 GARRETT AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-2533
Country	:	US
Telephone Number	:	225-252-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 EXECUTIVE CIR STE 38
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-8055
Country	:	US
Telephone Number	:	239-274-3681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	06/28/2024

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