Provider Demographics
NPI:1174772214
Name:SMALL, NANCY (MS RD L/DN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:MS RD L/DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 BRIDGEPOINTE CIR UNIT 40
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-6849
Mailing Address - Country:US
Mailing Address - Phone:716-861-5349
Mailing Address - Fax:
Practice Address - Street 1:1915 BRIDGEPOINTE CIR UNIT 40
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-6849
Practice Address - Country:US
Practice Address - Phone:716-861-5349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-13
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2733-1133V00000X, 133VN1004X
FLND6471133V00000X
FLND 6471222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric