Provider Demographics
NPI:1841653201
Name:WOODRUFF, ROBERTA KINDAL (RDN, LD)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:KINDAL
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 GRAND BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1897
Mailing Address - Country:US
Mailing Address - Phone:770-940-4013
Mailing Address - Fax:850-361-3364
Practice Address - Street 1:495 GRAND BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-1897
Practice Address - Country:US
Practice Address - Phone:770-940-4013
Practice Address - Fax:850-361-3364
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7682133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered