Provider Demographics
NPI:1811474695
Name:CONYERS, EMILY ROSE (MS, RDN, LD/N)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:CONYERS
Suffix:
Gender:
Credentials:MS, RDN, LD/N
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LD/N
Mailing Address - Street 1:12866 DAYBREAK CT E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7095
Mailing Address - Country:US
Mailing Address - Phone:904-497-0401
Mailing Address - Fax:833-773-1288
Practice Address - Street 1:12866 DAYBREAK CT E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7095
Practice Address - Country:US
Practice Address - Phone:904-497-0401
Practice Address - Fax:833-773-1288
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7660133N00000X, 133NN1002X, 133VN1005X, 133VN1101X, 133VN1201X, 133VN1501X, 133V00000X
GALD006417IU133N00000X, 133V00000X, 133VN1005X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, GerontologicalGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports DieteticsGroup - Multi-Specialty