Healthcare Provider Details

I. General information

NPI: 1366360539
Provider Name (Legal Business Name): YASMINE MENESES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11117 OAKSHORE LN
CLERMONT FL
34711-5409
US

IV. Provider business mailing address

11117 OAKSHORE LN
CLERMONT FL
34711-5409
US

V. Phone/Fax

Practice location:
  • Phone: 404-375-1507
  • Fax:
Mailing address:
  • Phone: 404-375-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND15214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: