Provider Demographics
NPI:1114552163
Name:ADDISON, AYASHA MARIA (RD, LD/N)
Entity Type:Individual
Prefix:MS
First Name:AYASHA
Middle Name:MARIA
Last Name:ADDISON
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 NW 7TH ST APT 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4437
Mailing Address - Country:US
Mailing Address - Phone:305-319-1343
Mailing Address - Fax:
Practice Address - Street 1:6640 NW 7TH ST APT 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4437
Practice Address - Country:US
Practice Address - Phone:305-319-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6730133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered