Provider Demographics
NPI:1780351965
Name:SNYDER, RHONDA JACKSON (RDN)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:JACKSON
Last Name:SNYDER
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 1:1373 DEXTER DR E
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7460
Mailing Address - Country:US
Mailing Address - Phone:386-589-9509
Mailing Address - Fax:
Practice Address - Street 1:1373 DEXTER DR E
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-7460
Practice Address - Country:US
Practice Address - Phone:386-589-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86065844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty