Provider Demographics
NPI:1245380302
Name:CEDENO, DOLLY (AC PRD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DOLLY
Middle Name:
Last Name:CEDENO
Suffix:
Gender:F
Credentials:AC PRD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 PINES BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6192
Mailing Address - Country:US
Mailing Address - Phone:954-447-1444
Mailing Address - Fax:954-447-2815
Practice Address - Street 1:10021 PINES BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6192
Practice Address - Country:US
Practice Address - Phone:954-447-1444
Practice Address - Fax:954-447-2815
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL925133V00000X
FLAP 2820171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811021200Medicaid