MEDICARE: JEREMIAH MICHAEL FARIAS RDN

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	133VN1006X	Metabolic Nutrition Registered Dietitian
2	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1649902347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH MICHAEL FARIAS RDN

Provider Business Mailing Address
First Line	:	2465 US 1 S # 1050
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6076
Country	:	US
Telephone Number	:	626-201-8945
Fax Number	:

Provider Business Practice Location Address
First Line	:	2465 US 1 S # 1050
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6076
Country	:	US
Telephone Number	:	626-201-8945
Fax Number	:

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

Provider Enumeration Date	:	06/30/2022
Last Update Date	:	10/22/2025

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