Healthcare Provider Details

I. General information

NPI: 1679857122
Provider Name (Legal Business Name): DENISE STEEL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 13TH AVE
INDIAN ROCKS BEACH FL
33785-3728
US

IV. Provider business mailing address

120 13TH AVE
INDIAN ROCKS BEACH FL
33785-3728
US

V. Phone/Fax

Practice location:
  • Phone: 715-410-0770
  • Fax:
Mailing address:
  • Phone: 715-410-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 4503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: