Healthcare Provider Details

I. General information

NPI: 1902443187
Provider Name (Legal Business Name): SHADIA HAMADEH MS, RDN, LDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9596 LAKE SERENA DR
BOCA RATON FL
33496-6517
US

IV. Provider business mailing address

9596 LAKE SERENA DR
BOCA RATON FL
33496-6517
US

V. Phone/Fax

Practice location:
  • Phone: 954-415-0142
  • Fax:
Mailing address:
  • Phone: 954-415-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberND6720
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND6720
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberND6720
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP-307088
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: