Provider Demographics
NPI:1265293872
Name:ALEXIDOR, NANCY (RDN/LDN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ALEXIDOR
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:ALEXIDOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NANCY ALEXIDOR RDN
Mailing Address - Street 1:4042 N PINE ISLAND RD APT 1A
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6525
Mailing Address - Country:US
Mailing Address - Phone:954-945-0016
Mailing Address - Fax:
Practice Address - Street 1:1621 SW 120TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3704
Practice Address - Country:US
Practice Address - Phone:954-945-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11984133VN1101X, 133VN1201X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management