MEDICARE: PLATEFUL OF YUM 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	:	1740686872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATEFUL OF YUM LLC

Provider Business Mailing Address
First Line	:	6901A N 9TH AVE # 588
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-6638
Country	:	US
Telephone Number	:	512-363-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	25060 GLENBROOKE DR
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-2514
Country	:	US
Telephone Number	:	512-363-9571
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS TITILAYO AYANWOLA
Credential	:	MPH, RD, LD
Telephone Number	:	512-363-9571

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	12/09/2024

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Directions to “PLATEFUL OF YUM LLC ” Practice Location

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