Provider Demographics
NPI:1831327881
Name:PEAN, MIKERLANDE (RD, LD/N)
Entity type:Individual
Prefix:MS
First Name:MIKERLANDE
Middle Name:
Last Name:PEAN
Suffix:
Gender:F
Credentials: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 1:15025 NW 11TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2013
Mailing Address - Country:US
Mailing Address - Phone:786-348-9507
Mailing Address - Fax:
Practice Address - Street 1:15025 NW 11TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2013
Practice Address - Country:US
Practice Address - Phone:786-348-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered