Provider Demographics
NPI:1538926241
Name:MEDERO, SAILY (RDN)
Entity type:Individual
Prefix:
First Name:SAILY
Middle Name:
Last Name:MEDERO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6492 PEMBERLEY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8141
Mailing Address - Country:US
Mailing Address - Phone:786-457-8291
Mailing Address - Fax:
Practice Address - Street 1:6492 PEMBERLEY LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8141
Practice Address - Country:US
Practice Address - Phone:786-457-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered