Basic Information
Provider Information
NPI: 1528586286
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEELE
FirstName: DEVIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RD, LD/N
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5255 HARBORSIDE DR
Address2:  
City: TAMPA
State: FL
PostalCode: 336153620
CountryCode: US
TelephoneNumber: 7273857063
FaxNumber:  
Practice Location
Address1: 5 TAMPA GENERAL CIR
Address2:  
City: TAMPA
State: FL
PostalCode: 336063601
CountryCode: US
TelephoneNumber: 8138447473
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2017
LastUpdateDate: 09/01/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XND8311FLY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


Home