Provider Demographics
NPI:1952042954
Name:CONNELLY, JENEENE MARIE (MS, RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:JENEENE
Middle Name:MARIE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:JENEENE
Other - Middle Name:MARIE
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 N FEDERAL HWY APT 705
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3874
Mailing Address - Country:US
Mailing Address - Phone:954-937-0429
Mailing Address - Fax:
Practice Address - Street 1:2301 N UNIVERSITY DR STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3617
Practice Address - Country:US
Practice Address - Phone:954-276-1400
Practice Address - Fax:954-322-8115
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10954133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty