Provider Demographics
NPI:1578179628
Name:GUY, GERMAINE (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:GERMAINE
Middle Name:
Last Name:GUY
Suffix:
Gender:M
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23482 GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2533
Mailing Address - Country:US
Mailing Address - Phone:225-252-4709
Mailing Address - Fax:
Practice Address - Street 1:4220 EXECUTIVE CIR STE 38
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-8055
Practice Address - Country:US
Practice Address - Phone:239-274-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9496133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered