Provider Demographics
NPI:1851094742
Name:SUPERSTEIN, MARINA (RDN)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SUPERSTEIN
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 1:6605 N WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2321
Mailing Address - Country:US
Mailing Address - Phone:954-591-6162
Mailing Address - Fax:
Practice Address - Street 1:6605 N WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2321
Practice Address - Country:US
Practice Address - Phone:954-591-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86360434133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered