Provider Demographics
NPI:1497164172
Name:BAND, HOLLY (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BAND
Suffix:
Gender:F
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 1:5431 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4639
Mailing Address - Country:US
Mailing Address - Phone:954-344-2522
Mailing Address - Fax:954-344-9154
Practice Address - Street 1:5431 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4639
Practice Address - Country:US
Practice Address - Phone:954-344-2522
Practice Address - Fax:954-344-9154
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5545133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic