Healthcare Provider Details

I. General information

NPI: 1649872763
Provider Name (Legal Business Name): DEBORAH JUDA RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 S FEDERAL HWY # 491
FT LAUDERDALE FL
33316-1257
US

IV. Provider business mailing address

1126 S FEDERAL HWY # 491
FT LAUDERDALE FL
33316-1257
US

V. Phone/Fax

Practice location:
  • Phone: 954-900-6428
  • Fax:
Mailing address:
  • Phone: 954-900-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: