MEDICARE: MRS. JEAN CARLUCCI DOSDOS R.D.,L.D

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	133V00000X	Registered Dietitian	ND 1510	FL

General Provider Information

NPI Number	:	1174523708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN CARLUCCI DOSDOS R.D.,L.D

Provider Business Mailing Address
First Line	:	107 JFK DR
Second Line	:	STE B
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1153
Country	:	US
Telephone Number	:	561-295-6962
Fax Number	:	561-249-2481

Provider Business Practice Location Address
First Line	:	5401 S CONGRESS AVE
Second Line	:	SUITE 201
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6635
Country	:	US
Telephone Number	:	561-641-7848
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/06/2017

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