MEDICARE: CAROLINE ROSS

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	ND5530	FL

General Provider Information

NPI Number	:	1851101323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE ROSS

Provider Business Mailing Address
First Line	:	2507 SAXON DR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-3429
Country	:	US
Telephone Number	:	630-337-7744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2507 SAXON DR
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-3429
Country	:	US
Telephone Number	:	630-337-7744
Fax Number	:

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

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	01/08/2025

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Directions to “ CAROLINE ROSS ” Practice Location

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