Healthcare Provider Details

I. General information

NPI: 1710111679
Provider Name (Legal Business Name): PATRICIA L. ROCHE MS, RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1598 TALLULAH TER
WESLEY CHAPEL FL
33543-7218
US

IV. Provider business mailing address

3031 GORHAM CT
CARMEL IN
46033-3280
US

V. Phone/Fax

Practice location:
  • Phone: 317-850-8497
  • Fax:
Mailing address:
  • Phone: 317-850-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number564375
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number564375
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number564375
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number564375
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: