MEDICARE: HEAL FROM FOOD

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

General Provider Information

NPI Number	:	1265065502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAL FROM FOOD

Provider Business Mailing Address
First Line	:	4300 LAKESIDE DR UNIT 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3364
Country	:	US
Telephone Number	:	917-306-1724
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 LAKESIDE DR UNIT 5
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3364
Country	:	US
Telephone Number	:	917-306-1724
Fax Number	:

Authorized Official
Title or Position	:	FUNCTIONAL NUTRITION DIETITIAN
Name	:	STACY SESLOWSKY
Credential	:	RD
Telephone Number	:	917-306-1724

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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Directions to “HEAL FROM FOOD ” Practice Location

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