MEDICARE: ART OF LIVING HEALTHY, LLC

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 4603	FL

General Provider Information

NPI Number	:	1184179608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ART OF LIVING HEALTHY, LLC

Provider Business Mailing Address
First Line	:	19046 LAKE SWATARA DR
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32736-7709
Country	:	US
Telephone Number	:	352-228-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 W OLD US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-3526
Country	:	US
Telephone Number	:	352-729-6877
Fax Number	:	352-729-6877

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	MS. MARY ANN KALONICK
Credential	:	RD
Telephone Number	:	352-228-3050

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	10/12/2016

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