Provider Demographics
NPI:1700693595
Name:KAREN REYNOLDS RDN LD LLC
Entity type:Organization
Organization Name:KAREN REYNOLDS RDN LD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:917-817-8163
Mailing Address - Street 1:477 ARBORVIEW LN
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-5312
Mailing Address - Country:US
Mailing Address - Phone:917-817-8163
Mailing Address - Fax:
Practice Address - Street 1:2886 RINGLING BLVD STE D
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5331
Practice Address - Country:US
Practice Address - Phone:917-817-8163
Practice Address - Fax:941-584-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty