Provider Demographics
NPI:1679855423
Name:FLEISHER, JACQUELINE Z (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:Z
Last Name:FLEISHER
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 1:325 IVES DAIRY RD
Mailing Address - Street 2:# 01
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3327
Mailing Address - Country:US
Mailing Address - Phone:305-206-3388
Mailing Address - Fax:305-691-2144
Practice Address - Street 1:325 IVES DAIRY RD
Practice Address - Street 2:# 01
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-3327
Practice Address - Country:US
Practice Address - Phone:305-206-3388
Practice Address - Fax:305-691-2144
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND0000884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered