Healthcare Provider Details

I. General information

NPI: 1689503211
Provider Name (Legal Business Name): DIETITIAN CONCIERGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7704 HEYWARD CIR
BRADENTON FL
34201-2049
US

IV. Provider business mailing address

7704 HEYWARD CIR
BRADENTON FL
34201-2049
US

V. Phone/Fax

Practice location:
  • Phone: 631-896-3950
  • Fax:
Mailing address:
  • Phone: 631-896-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA CIRAOLO SCHMEISING
Title or Position: REGISTERED DIETITIAN
Credential: RDN,LD
Phone: 631-896-3950