Provider Demographics
NPI:1407462690
Name:DEINHART, MARYJO (RDN)
Entity Type:Individual
Prefix:
First Name:MARYJO
Middle Name:
Last Name:DEINHART
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 RIVERWAY DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-9671
Mailing Address - Country:US
Mailing Address - Phone:315-491-5911
Mailing Address - Fax:
Practice Address - Street 1:5901 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2117
Practice Address - Country:US
Practice Address - Phone:863-471-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered