Provider Demographics
NPI:1992395032
Name:MALDONADO HERNANDEZ, LLYAMARIE (RD)
Entity Type:Individual
Prefix:
First Name:LLYAMARIE
Middle Name:
Last Name:MALDONADO HERNANDEZ
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 1:296 ARBOR LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8167
Mailing Address - Country:US
Mailing Address - Phone:407-449-3978
Mailing Address - Fax:
Practice Address - Street 1:296 ARBOR LAKES DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-8167
Practice Address - Country:US
Practice Address - Phone:407-449-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86082654133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered