MEDICARE: AMY CARRILLO

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	10687	FL

General Provider Information

NPI Number	:	1821885088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CARRILLO

Provider Business Mailing Address
First Line	:	2315 AURELIUS DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-9203
Country	:	US
Telephone Number	:	352-571-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 AURELIUS DR
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-9203
Country	:	US
Telephone Number	:	352-571-8431
Fax Number	:

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

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	04/22/2025

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Directions to “ AMY CARRILLO ” Practice Location

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