Provider Demographics
NPI:1083493373
Name:QUINONES, MICHELLE A (RDN,LDN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:QUINONES
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-4654
Mailing Address - Country:US
Mailing Address - Phone:305-467-3699
Mailing Address - Fax:
Practice Address - Street 1:13005 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4654
Practice Address - Country:US
Practice Address - Phone:305-467-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12438133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered