MEDICARE: ANDREA SOLLENBERGER RD, RDN, 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	133N00000X	Nutritionist	639704	FL
2	133NN1002X	Nutrition Education Nutritionist	639704	FL
3	133V00000X	Registered Dietitian	639704	FL
4	133VN1004X	Pediatric Nutrition Registered Dietitian	639704	FL
5	133VN1005X	Renal Nutrition Registered Dietitian	639704	FL
6	133VN1006X	Metabolic Nutrition Registered Dietitian	639704	FL

General Provider Information

NPI Number	:	1376946632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SOLLENBERGER RD, RDN, LD/N

Provider Business Mailing Address
First Line	:	4423 NW 6TH PL STE A
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-6116
Country	:	US
Telephone Number	:	352-213-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	4423 NW 6TH PL STE A
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-6116
Country	:	US
Telephone Number	:	352-213-1250
Fax Number	:

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

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	10/01/2014

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