MEDICARE: LAURA VAZZO MCDEVITT M.ED.,R.D.,LD/N

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	ND5548	FL

General Provider Information

NPI Number	:	1184901290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA VAZZO MCDEVITT M.ED.,R.D.,LD/N

Provider Business Mailing Address
First Line	:	428 CLEARWATER DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4170
Country	:	US
Telephone Number	:	904-469-1717
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 CLEARWATER DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4170
Country	:	US
Telephone Number	:	904-469-1717
Fax Number	:

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

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	11/03/2011

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