MEDICARE: SHAPES NUTRITION AND WELLNESS

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	954272	PR

General Provider Information

NPI Number	:	1457668568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAPES NUTRITION AND WELLNESS

Provider Business Mailing Address
First Line	:	4304 ALTON RD
Second Line	:	APT 209
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140
Country	:	US
Telephone Number	:	786-525-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	923 41ST STREET
Second Line	:	SUITE 102
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2885
Country	:	US
Telephone Number	:	305-647-1985
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN
Name	:	MELISSA ORTIZ
Credential	:	RD,LN/D
Telephone Number	:	305-647-1985

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/22/2010

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Directions to “SHAPES NUTRITION AND WELLNESS ” Practice Location

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