Provider Demographics
NPI:1265016505
Name:GLAZER, SHEILA (RD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:GLAZER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S OCEAN LN APT 1411
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3826
Mailing Address - Country:US
Mailing Address - Phone:561-289-5682
Mailing Address - Fax:
Practice Address - Street 1:2100 S OCEAN LN APT 1411
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3826
Practice Address - Country:US
Practice Address - Phone:561-289-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86067054133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty