Provider Demographics
NPI:1902151442
Name:MICHAEL, TERRI L (MS, RD, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:L
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7237 SE SWAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-4529
Mailing Address - Country:US
Mailing Address - Phone:561-866-4517
Mailing Address - Fax:
Practice Address - Street 1:5455 N FEDERAL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4994
Practice Address - Country:US
Practice Address - Phone:561-866-4517
Practice Address - Fax:561-852-7352
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6299133V00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No251S00000XAgenciesCommunity/Behavioral Health