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NPI Code Detail

MEDICARE: AYLEEN PORTER-LUKE M.A., RDN, LDN

MEDICARE:   AYLEEN  PORTER-LUKE  M.A., RDN, LDN
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
1133N00000XNutritionistND 6990FL
2133V00000XRegistered DietitianND 6990FL

General Provider Information

NPI Number : 1982075784
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYLEEN PORTER-LUKE M.A., RDN, LDN
Provider Business Mailing Address
First Line : 145 MARTIN CIR
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-1708
Country : US
Telephone Number : 917-482-6161
Fax Number :
Provider Business Practice Location Address
First Line : 145 MARTIN CIR
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-1708
Country : US
Telephone Number : 917-482-6161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2015
Last Update Date : 10/19/2015

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