Healthcare Provider Details

I. General information

NPI: 1699175018
Provider Name (Legal Business Name): ELISA EPSTEIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NW 7TH AVE THIRD FLOOR
FORT LAUDERDALE FL
33311-9026
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-759-6733
  • Fax:
Mailing address:
  • Phone: 954-759-6600
  • Fax: 954-759-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: