Provider Demographics
NPI:1831267335
Name:DEWIT, DIANE ELISE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ELISE
Last Name:DEWIT
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9506
Mailing Address - Fax:
Practice Address - Street 1:8725 N WICKHAM RD
Practice Address - Street 2:VIERA HOSPITAL MEDICAL PLAZA
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-2239
Practice Address - Country:US
Practice Address - Phone:321-434-9506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLO7103OtherMEDICARE HF