Provider Demographics
NPI:1902443187
Name:HAMADEH, SHADIA (MS, RDN, LDN, CLC)
Entity Type:Individual
Prefix:MRS
First Name:SHADIA
Middle Name:
Last Name:HAMADEH
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9596 LAKE SERENA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-6517
Mailing Address - Country:US
Mailing Address - Phone:954-415-0142
Mailing Address - Fax:
Practice Address - Street 1:9596 LAKE SERENA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-6517
Practice Address - Country:US
Practice Address - Phone:954-415-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6720133NN1002X, 133VN1004X, 133VN1201X, 133V00000X
FLALPP-307088174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No174N00000XOther Service ProvidersLactation Consultant, Non-RN