Provider Demographics
NPI:1821446261
Name:JENNIFER MASSON RD LLC
Entity Type:Organization
Organization Name:JENNIFER MASSON RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:727-455-9066
Mailing Address - Street 1:2409 HUNTINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5235
Mailing Address - Country:US
Mailing Address - Phone:727-723-9191
Mailing Address - Fax:
Practice Address - Street 1:2409 HUNTINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-5235
Practice Address - Country:US
Practice Address - Phone:727-723-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty