Healthcare Provider Details

I. General information

NPI: 1104504885
Provider Name (Legal Business Name): AMY ZOGRAN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 NEBRASKA ST
ORLANDO FL
32803-1920
US

IV. Provider business mailing address

1608 NEBRASKA ST
ORLANDO FL
32803-1920
US

V. Phone/Fax

Practice location:
  • Phone: 321-806-5386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND12251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: