MEDICARE: MEDICAL DIETITIANS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1053028415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL DIETITIANS LLC

Provider Business Mailing Address
First Line	:	229 45TH AVE
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-2524
Country	:	US
Telephone Number	:	813-460-8792
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 45TH AVE
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-2524
Country	:	US
Telephone Number	:	181-346-0879
Fax Number	:

Authorized Official
Title or Position	:	OWNER/REGISTERED DIETITIAN
Name	:	MARCIA OF SCHULTZ
Credential	:	MPH RD LDN CDCES
Telephone Number	:	813-460-8792

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	12/02/2022

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