Healthcare Provider Details

I. General information

NPI: 1821978743
Provider Name (Legal Business Name): FIDELA GJONDREKAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

IV. Provider business mailing address

2930 SW 23RD TER # U3108
GAINESVILLE FL
32608-2956
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5050
  • Fax: 352-294-8058
Mailing address:
  • Phone: 904-510-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberND14086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: