Provider Demographics
NPI:1174857478
Name:MEEHAN, JASON THOMAS (RD, LD/N)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:THOMAS
Last Name:MEEHAN
Suffix:
Gender:M
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 1:3210 WHEELING CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8046
Mailing Address - Country:US
Mailing Address - Phone:813-787-1828
Mailing Address - Fax:
Practice Address - Street 1:3210 WHEELING CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-8046
Practice Address - Country:US
Practice Address - Phone:813-787-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered