MEDICARE: REBECCA WASHUTA

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	ND9777	FL

General Provider Information

NPI Number	:	1467078279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA WASHUTA

Provider Business Mailing Address
First Line	:	400 ALTON RD APT 1005
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-6737
Country	:	US
Telephone Number	:	908-868-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 ALTON RD APT 1005
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-6737
Country	:	US
Telephone Number	:	908-868-0806
Fax Number	:

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

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	06/18/2020

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Directions to “ REBECCA WASHUTA ” Practice Location

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