Provider Demographics
NPI:1235341082
Name:HAMVAI, MARY BETH (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:HAMVAI
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11567 57TH ST. CIR. E.
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219
Mailing Address - Country:US
Mailing Address - Phone:941-932-4412
Mailing Address - Fax:
Practice Address - Street 1:BLAKE MEDICAL CENTER
Practice Address - Street 2:2020 59TH ST. W.
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-798-6135
Practice Address - Fax:941-798-6023
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1828133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0202ZMedicare UPIN