Provider Demographics
NPI:1912526104
Name:AYESTA, ANDRES EDUARDO (RD, LD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:EDUARDO
Last Name:AYESTA
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 N JAMAICA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3348
Mailing Address - Country:US
Mailing Address - Phone:812-604-0958
Mailing Address - Fax:
Practice Address - Street 1:7804 N JAMAICA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3348
Practice Address - Country:US
Practice Address - Phone:812-604-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty