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NPI Code Detail

MEDICARE: MS. RANDI BETH FREEDMAN RD, LDN

MEDICARE: MS. RANDI BETH FREEDMAN RD, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian960359NJ
2133V00000XRegistered DietitianND 7770FL

General Provider Information

NPI Number : 1245355866
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RANDI BETH FREEDMAN RD, LDN
Provider Business Mailing Address
First Line : 2504 SE ANCHORAGE CV
Second Line : APT B3
City : PORT SAINT LUCIE
State : FL
Zip : 34952-6223
Country : US
Telephone Number : 908-300-6081
Fax Number :
Provider Business Practice Location Address
First Line : 356 E MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7148
Country : US
Telephone Number : 908-300-6081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 12/31/2016

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