Provider Demographics
NPI:1083378830
Name:RANEW, MADISON LYNN (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LYNN
Last Name:RANEW
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:LYNN
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 PERGOLA PL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1061
Mailing Address - Country:US
Mailing Address - Phone:352-201-1947
Mailing Address - Fax:
Practice Address - Street 1:551 NATIONAL HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1495
Practice Address - Country:US
Practice Address - Phone:386-323-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered