Provider Demographics
NPI:1982070447
Name:DE AGUIAR, ANNABELLE SCHIFFERDECKER (RD, CD-N)
Entity Type:Individual
Prefix:MRS
First Name:ANNABELLE
Middle Name:SCHIFFERDECKER
Last Name:DE AGUIAR
Suffix:
Gender:F
Credentials:RD, CD-N
Other - Prefix:
Other - First Name:ANNABELLE
Other - Middle Name:GRACE
Other - Last Name:SCHIFFERDECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:245 PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-463-4482
Mailing Address - Fax:
Practice Address - Street 1:520 S PARK RD
Practice Address - Street 2:12-23
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8595
Practice Address - Country:US
Practice Address - Phone:860-463-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered