MEDICARE: LAUREN WONG ROBINSON RD, LDN

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	DX5716	MD
2	133V00000X	Registered Dietitian	ND11913	FL

General Provider Information

NPI Number	:	1518785260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN WONG ROBINSON RD, LDN

Provider Business Mailing Address
First Line	:	7600 MAJORCA PL APT 2014
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5541
Country	:	US
Telephone Number	:	410-733-8214
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 CALYPSO CAY WAY
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-5520
Country	:	US
Telephone Number	:	321-286-3374
Fax Number	:

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

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	10/08/2024

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