MEDICARE: MRS. JULIANE BARBOSA RABELO NC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1043720568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIANE BARBOSA RABELO NC

Provider Business Mailing Address
First Line	:	2 EASTBOURNE AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-6146
Country	:	US
Telephone Number	:	908-309-1242
Fax Number	:	908-309-1242

Provider Business Practice Location Address
First Line	:	2 EASTBOURNE AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-6146
Country	:	US
Telephone Number	:	908-309-1242
Fax Number	:	908-309-1242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	10/11/2017

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