Provider Demographics
NPI:1134560923
Name:FRYBURGER, NATHANIEL AARON (RD, LD/N)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:AARON
Last Name:FRYBURGER
Suffix:
Gender:M
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10841 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-2513
Mailing Address - Country:US
Mailing Address - Phone:727-861-5250
Mailing Address - Fax:727-863-9734
Practice Address - Street 1:10841 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-2513
Practice Address - Country:US
Practice Address - Phone:727-861-5250
Practice Address - Fax:727-863-9734
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6565133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered