Provider Demographics
NPI:1740239409
Name:HYLLEDIG, LORNA CAROLYN (EDD,RD, LD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:CAROLYN
Last Name:HYLLEDIG
Suffix:
Gender:F
Credentials:EDD,RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 SW SUNDANCE TRL
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-8219
Mailing Address - Country:US
Mailing Address - Phone:770-331-4955
Mailing Address - Fax:
Practice Address - Street 1:463 SW SUNDANCE TRL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-8219
Practice Address - Country:US
Practice Address - Phone:770-331-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND8718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1LKANOtherFLORIDA BLUE
11214069OtherCAQH PROVIDER ID
1740239409OtherNPI
FLQC596OtherMEDICARE