Healthcare Provider Details

I. General information

NPI: 1376847004
Provider Name (Legal Business Name): DEVIN P BREEDON RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W HIGHWAY 40 STE 700
OCALA FL
34482-8517
US

IV. Provider business mailing address

4083 SW 49TH TER
OCALA FL
34474-9684
US

V. Phone/Fax

Practice location:
  • Phone: 352-462-3602
  • Fax: 352-352-9390
Mailing address:
  • Phone: 734-755-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: