Provider Demographics
NPI:1689367716
Name:RIVANI, KRYSTAL AMANDA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:AMANDA
Last Name:RIVANI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 N MERIDIAN AVE UNIT 702
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2966
Mailing Address - Country:US
Mailing Address - Phone:626-419-6490
Mailing Address - Fax:
Practice Address - Street 1:4701 N MERIDIAN AVE UNIT 702
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2966
Practice Address - Country:US
Practice Address - Phone:626-419-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86016116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered