Provider Demographics
NPI:1982750428
Name:HEALTHY AGENDAS PA
Entity Type:Organization
Organization Name:HEALTHY AGENDAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAMET
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:954-475-4262
Mailing Address - Street 1:140 S UNIVERSITY DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3358
Mailing Address - Country:US
Mailing Address - Phone:954-475-4262
Mailing Address - Fax:
Practice Address - Street 1:140 S UNIVERSITY DR
Practice Address - Street 2:SUITE D
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3358
Practice Address - Country:US
Practice Address - Phone:954-475-4262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2550896OtherAETNA HMO
FL281445OtherAV-MED
FL2550896OtherAETNA HMO