Healthcare Provider Details

I. General information

NPI: 1376203224
Provider Name (Legal Business Name): ALISSA HOSEIN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 LAWTON RD STE 2A
ORLANDO FL
32803-2948
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 407-751-2867
  • Fax: 888-720-4569
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberND14731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: