Healthcare Provider Details

I. General information

NPI: 1619394384
Provider Name (Legal Business Name): AIMEE MOLINEAUX RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S ORANGE AVE SUITE #100
ORLANDO FL
32806-2944
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPARTMENT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-7000
  • Fax: 407-567-5924
Mailing address:
  • Phone: 302-651-6212
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND5430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: