MEDICARE: PAUL D FULDAUER RD

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	5965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578294666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL D FULDAUER RD

Provider Business Mailing Address
First Line	:	PO BOX 100286
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0286
Country	:	US
Telephone Number	:	352-265-0535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 E HALIFAX CROSSING BLVD
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-2911
Country	:	US
Telephone Number	:	386-425-6000
Fax Number	:

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

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	01/21/2026

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