MEDICARE: LUANA WOLFFENBUTTEL SERRETIELLO RD

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	12665	FL

General Provider Information

NPI Number	:	1477374577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUANA WOLFFENBUTTEL SERRETIELLO RD

Provider Business Mailing Address
First Line	:	637 W ARTESIA ST
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-8155
Country	:	US
Telephone Number	:	407-749-7268
Fax Number	:

Provider Business Practice Location Address
First Line	:	6965 PIAZZA GRANDE AVE STE 210
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8780
Country	:	US
Telephone Number	:	407-749-7268
Fax Number	:

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

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	04/28/2025

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