Provider Demographics
NPI:1023687969
Name:ACEVEDO, ANHTONY (PHD-C, LDN)
Entity type:Individual
Prefix:PROF
First Name:ANHTONY
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:PHD-C, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4118
Mailing Address - Country:US
Mailing Address - Phone:443-949-4207
Mailing Address - Fax:
Practice Address - Street 1:1927 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4118
Practice Address - Country:US
Practice Address - Phone:443-949-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX5317133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist