Provider Demographics
NPI:1134643687
Name:REILLY, WENDIMERE (RDN)
Entity type:Individual
Prefix:
First Name:WENDIMERE
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ROBBINS REST CIR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-5204
Mailing Address - Country:US
Mailing Address - Phone:638-660-9406
Mailing Address - Fax:863-400-2347
Practice Address - Street 1:216 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5197
Practice Address - Country:US
Practice Address - Phone:863-660-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8330133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered