Provider Demographics
NPI:1780402511
Name:GARYANTES, MONIKA (RD, LDN)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:GARYANTES
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 CHESAPEAKE CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2625
Mailing Address - Country:US
Mailing Address - Phone:727-459-1563
Mailing Address - Fax:
Practice Address - Street 1:1926 CHESAPEAKE CT
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2625
Practice Address - Country:US
Practice Address - Phone:727-459-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12459133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered