Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 8894 | FL |
NPI | 1639634090 |
---|---|
Provider Name | Scott T Damanti |
First Address | Clearwater, FL 33755-4815 |
Second Address | Clearwater, FL 33755-4815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2019 |
Last Update Date | 09/02/2019 |