Provider Demographics
NPI:1568141786
Name:BACKMAN, CHANA LEAH (RD)
Entity Type:Individual
Prefix:
First Name:CHANA LEAH
Middle Name:
Last Name:BACKMAN
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 1:9801 COLLINS AVE APT 6H
Mailing Address - Street 2:
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1828
Mailing Address - Country:US
Mailing Address - Phone:917-225-1194
Mailing Address - Fax:
Practice Address - Street 1:9801 COLLINS AVE APT 6H
Practice Address - Street 2:
Practice Address - City:BAL HARBOUR
Practice Address - State:FL
Practice Address - Zip Code:33154-1828
Practice Address - Country:US
Practice Address - Phone:917-225-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered