Provider Demographics
NPI:1578287538
Name:MISHAAN, LILIANNE FRIEDA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LILIANNE
Middle Name:FRIEDA
Last Name:MISHAAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 COLLINS AVE APT 905
Mailing Address - Street 2:
Mailing Address - City:BAL HARBOUR
Mailing Address - State:FL
Mailing Address - Zip Code:33154-1664
Mailing Address - Country:US
Mailing Address - Phone:305-205-5371
Mailing Address - Fax:
Practice Address - Street 1:10175 COLLINS AVE APT 905
Practice Address - Street 2:
Practice Address - City:BAL HARBOUR
Practice Address - State:FL
Practice Address - Zip Code:33154-1664
Practice Address - Country:US
Practice Address - Phone:305-205-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered