Healthcare Provider Details

I. General information

NPI: 1477216505
Provider Name (Legal Business Name): LEDA PATRICIA MEDINA RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14304 FREDRICKSBURG DR APT 403
ORLANDO FL
32837-8619
US

IV. Provider business mailing address

14304 FREDRICKSBURG DR APT 403
ORLANDO FL
32837-8619
US

V. Phone/Fax

Practice location:
  • Phone: 305-484-1377
  • Fax:
Mailing address:
  • Phone: 305-484-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberND6607
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: