MEDICARE: SHEILA GLAZER RD

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	86067054	FL

General Provider Information

NPI Number	:	1265016505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA GLAZER RD

Provider Business Mailing Address
First Line	:	2100 S OCEAN LN APT 1411
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-3826
Country	:	US
Telephone Number	:	561-289-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 S OCEAN LN APT 1411
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-3826
Country	:	US
Telephone Number	:	561-289-5682
Fax Number	:

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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