Healthcare Provider Details

I. General information

NPI: 1811240757
Provider Name (Legal Business Name): DEENA YEAMANS RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date: 12/17/2015
Reactivation Date: 01/11/2022

III. Provider practice location address

21301 POWERLINE RD STE 107
BOCA RATON FL
33433-2389
US

IV. Provider business mailing address

7440 SAN CLEMENTE PL
BOCA RATON FL
33433-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-5067
  • Fax:
Mailing address:
  • Phone: 786-763-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number876124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: