Provider Demographics
NPI:1508514993
Name:NOVIKOV, DMITRIY (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:DMITRIY
Middle Name:
Last Name:NOVIKOV
Suffix:
Gender:M
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 1:2711 N HIGHWAY A1A UNIT D
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34949-1569
Mailing Address - Country:US
Mailing Address - Phone:305-788-1714
Mailing Address - Fax:772-402-3462
Practice Address - Street 1:2711 N HIGHWAY A1A UNIT D
Practice Address - Street 2:
Practice Address - City:HUTCHINSON ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34949-1569
Practice Address - Country:US
Practice Address - Phone:305-788-1714
Practice Address - Fax:772-402-3462
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8796133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered