Provider Demographics
NPI:1891363776
Name:RONEY, PAMELA J (RD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:RONEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 W KENNEDY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2457
Mailing Address - Country:US
Mailing Address - Phone:888-964-1975
Mailing Address - Fax:877-743-5351
Practice Address - Street 1:5401 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2428
Practice Address - Country:US
Practice Address - Phone:888-964-1975
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10197133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND10197OtherFLORIDA DEPT. OF HEALTH