Provider Demographics
NPI:1962668459
Name:CULLUM, VALERIE B (RD,LD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:B
Last Name:CULLUM
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-3320
Mailing Address - Country:US
Mailing Address - Phone:352-540-6800
Mailing Address - Fax:352-754-4132
Practice Address - Street 1:300 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3320
Practice Address - Country:US
Practice Address - Phone:352-540-6800
Practice Address - Fax:352-754-4132
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND939133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered