Provider Demographics
NPI:1174713416
Name:MOHAMED, SHABEENA (RD, LDN)
Entity type:Individual
Prefix:
First Name:SHABEENA
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
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 1:363 SKY VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5285
Mailing Address - Country:US
Mailing Address - Phone:352-227-4925
Mailing Address - Fax:
Practice Address - Street 1:363 SKY VALLEY ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5285
Practice Address - Country:US
Practice Address - Phone:352-227-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4761133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered