Healthcare Provider Details

I. General information

NPI: 1245107333
Provider Name (Legal Business Name): ALISON LIEBERMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 FOREST HILL BLVD STE 244A
WELLINGTON FL
33414-3128
US

IV. Provider business mailing address

10300 FOREST HILL BLVD
WELLINGTON FL
33414-3120
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-6154
  • Fax:
Mailing address:
  • Phone: 561-866-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number14613
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: