Provider Demographics
NPI:1164224291
Name:GOODMAN, DEVYN LILY (MS, RDN)
Entity type:Individual
Prefix:
First Name:DEVYN
Middle Name:LILY
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3269 COUNTRYSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2217
Mailing Address - Country:US
Mailing Address - Phone:248-420-4248
Mailing Address - Fax:
Practice Address - Street 1:42505 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5147
Practice Address - Country:US
Practice Address - Phone:248-771-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86359233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered