Provider Demographics
NPI:1174523708
Name:DOSDOS, JEAN CARLUCCI (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:CARLUCCI
Last Name:DOSDOS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JFK DR
Mailing Address - Street 2:STE B
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1153
Mailing Address - Country:US
Mailing Address - Phone:561-295-6962
Mailing Address - Fax:561-249-2481
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-641-7848
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1510133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0009Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY