Healthcare Provider Details

I. General information

NPI: 1942996707
Provider Name (Legal Business Name): PAOLA ROSSY OTHON MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 GRANDE RESERVE WAY APT 308
ORLANDO FL
32837-4110
US

IV. Provider business mailing address

3639 GRANDE RESERVE WAY APT 308
ORLANDO FL
32837-4110
US

V. Phone/Fax

Practice location:
  • Phone: 850-559-3551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License NumberND11632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: