Provider Demographics
NPI:1780301002
Name:MCDERMOTT, SHARAYAH (RD, LD)
Entity type:Individual
Prefix:
First Name:SHARAYAH
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LD
Mailing Address - Street 1:5579 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5579 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:FL
Practice Address - Zip Code:32809-3493
Practice Address - Country:US
Practice Address - Phone:407-241-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7358133V00000X
FL1017410133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered