MEDICARE: AARON ANDREW FLETCHER RD, LD

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	LD.7790	OH

General Provider Information

NPI Number	:	1336947548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON ANDREW FLETCHER RD, LD

Provider Business Mailing Address
First Line	:	8172 LAKE SHORE BLVD
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-1458
Country	:	US
Telephone Number	:	440-725-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	2061 CORNELL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3808
Country	:	US
Telephone Number	:	216-844-2463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/04/2025

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