MEDICARE: LAUREL SAVOY RD, LD, CDE

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 2868	FL

General Provider Information

NPI Number	:	1366633992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL SAVOY RD, LD, CDE

Provider Business Mailing Address
First Line	:	2115 CANNOLOT BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-3324
Country	:	US
Telephone Number	:	941-624-4823
Fax Number	:	941-624-4823

Provider Business Practice Location Address
First Line	:	2115 CANNOLOT BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-3324
Country	:	US
Telephone Number	:	941-624-4823
Fax Number	:	941-624-4823

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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