Provider Demographics
NPI:1811965023
Name:ALLEN, NOVEL GOERGIA (MS, RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:NOVEL
Middle Name:GOERGIA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18262 SW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5183
Mailing Address - Country:US
Mailing Address - Phone:954-441-7578
Mailing Address - Fax:
Practice Address - Street 1:12379 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1723
Practice Address - Country:US
Practice Address - Phone:954-205-3296
Practice Address - Fax:954-885-0363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered