Provider Demographics
NPI:1043596927
Name:WEDMAN-ST. LOUIS, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:WEDMAN-ST. LOUIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:WEDMAN-ST. LOUIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:17920 GULF BLVD
Mailing Address - Street 2:STE 606
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708
Mailing Address - Country:US
Mailing Address - Phone:727-391-6198
Mailing Address - Fax:727-399-2188
Practice Address - Street 1:17920 GULF BLVD
Practice Address - Street 2:STE 606
Practice Address - City:REDINGTON SHORES
Practice Address - State:FL
Practice Address - Zip Code:33708
Practice Address - Country:US
Practice Address - Phone:727-391-6198
Practice Address - Fax:727-399-2188
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1455133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered