Healthcare Provider Details

I. General information

NPI: 1811725898
Provider Name (Legal Business Name): MICHELLE MARIE ALVEAR CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 BUICK AVE
MELBOURNE FL
32935-4907
US

IV. Provider business mailing address

1711 BUICK AVE
MELBOURNE FL
32935-4907
US

V. Phone/Fax

Practice location:
  • Phone: 703-398-1159
  • Fax:
Mailing address:
  • Phone: 703-398-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX6769
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDX6769
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: