Healthcare Provider Details

I. General information

NPI: 1720788847
Provider Name (Legal Business Name): YESENIA CHEDIAK RDN, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N COMMERCE PKWY STE 200
WESTON FL
33326-3258
US

IV. Provider business mailing address

2200 N COMMERCE PKWY STE 200
WESTON FL
33326-3258
US

V. Phone/Fax

Practice location:
  • Phone: 954-357-3180
  • Fax:
Mailing address:
  • Phone: 954-357-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1067825
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164009278
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND7883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: