MEDICARE: MRS. JAIME MICHELLE DIMATTIO 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.7394	OH

General Provider Information

NPI Number	:	1750792594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAIME MICHELLE DIMATTIO RD,LD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-444-5329
Fax Number	:	216-445-1521

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-6053
Country	:	US
Telephone Number	:	216-444-5329
Fax Number	:	216-445-1521

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

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	07/21/2022

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