Provider Demographics
NPI:1659090199
Name:REGNELL, MARIE THERESE (RD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:THERESE
Last Name:REGNELL
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 1:4155 BANYAN TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5103
Mailing Address - Country:US
Mailing Address - Phone:754-245-5136
Mailing Address - Fax:
Practice Address - Street 1:5772 NW 48TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4000
Practice Address - Country:US
Practice Address - Phone:954-614-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9367133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered