Provider Demographics
NPI:1174316566
Name:SOLOMON, DANIEL (RD/LDN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21445
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33742-1445
Mailing Address - Country:US
Mailing Address - Phone:813-489-9151
Mailing Address - Fax:
Practice Address - Street 1:11675 DR MARTIN LUTHER KING JR ST N APT 8
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2323
Practice Address - Country:US
Practice Address - Phone:813-489-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4686133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered