Provider Demographics
NPI:1295161040
Name:THE DIETITIANS GROUP OF WEST FLORIDA, INC.
Entity type:Organization
Organization Name:THE DIETITIANS GROUP OF WEST FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WITKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CDE, LDN
Authorized Official - Phone:727-376-9757
Mailing Address - Street 1:7143 STATE ROAD 54 UNIT 121
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6104
Mailing Address - Country:US
Mailing Address - Phone:727-376-9757
Mailing Address - Fax:727-245-8670
Practice Address - Street 1:34921 US HIGHWAY 19 N STE 340
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1969
Practice Address - Country:US
Practice Address - Phone:727-376-9757
Practice Address - Fax:727-245-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP829WMedicare PIN
FLBP829XMedicare PIN