Provider Demographics
NPI:1164769360
Name:POCZEKAJ, MEGAN (RD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:POCZEKAJ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 VIRGINIA DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2526
Mailing Address - Country:US
Mailing Address - Phone:407-720-8636
Mailing Address - Fax:
Practice Address - Street 1:1011 VIRGINIA DR STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-2526
Practice Address - Country:US
Practice Address - Phone:407-720-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7221133V00000X
FLND6013133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered