Provider Demographics
NPI:1073285102
Name:KUMAR CARDOSO, DIVYA (RDN/LDN)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:KUMAR CARDOSO
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:DIVYA
Other - Middle Name:
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN/LDN
Mailing Address - Street 1:9334 MUSTARD LEAF DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9334 MUSTARD LEAF DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7082
Practice Address - Country:US
Practice Address - Phone:813-380-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6268133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty