Provider Demographics
NPI:1992015424
Name:YOUNG, DIANA KAE (RD, LD/N, CDE)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:KAE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RD, LD/N, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FEARON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2829
Mailing Address - Country:US
Mailing Address - Phone:352-735-8110
Mailing Address - Fax:
Practice Address - Street 1:182 FEARON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2829
Practice Address - Country:US
Practice Address - Phone:352-735-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2459133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered