Healthcare Provider Details

I. General information

NPI: 1619890837
Provider Name (Legal Business Name): JULIE CHAU INLAVONGSA RD, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4912 CYPRESS LINKS BLVD
ELKTON FL
32033-2064
US

IV. Provider business mailing address

4912 CYPRESS LINKS BLVD
ELKTON FL
32033-2064
US

V. Phone/Fax

Practice location:
  • Phone: 512-693-7045
  • Fax: 512-399-9039
Mailing address:
  • Phone: 512-693-7045
  • Fax: 512-399-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1033199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: