Basic Information
| Provider Information | |||||||||
| NPI: | 1467903161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ-MARRERO | ||||||||
| FirstName: | NEYSHA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 SW ARCHER RD BOX 100325 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650400 | ||||||||
| FaxNumber: | 3522651071 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326102222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650400 | ||||||||
| FaxNumber: | 3522651071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133N00000X | N | Dietary & Nutritional Service Providers | Nutritionist | 133V00000X | ND8447 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.