Provider Demographics
NPI:1780865881
Name:WITT, MEGAN DANAE (RD, LD, CLT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DANAE
Last Name:WITT
Suffix:
Gender:F
Credentials:RD, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-5929
Mailing Address - Country:US
Mailing Address - Phone:941-914-6659
Mailing Address - Fax:941-474-4080
Practice Address - Street 1:1340 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-5929
Practice Address - Country:US
Practice Address - Phone:941-914-6659
Practice Address - Fax:941-474-4080
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3666133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered