Provider Demographics
NPI:1487860235
Name:ZAVALA, GISELLE (RDN LD)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11921 WATER RUN ALY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-0235
Mailing Address - Country:US
Mailing Address - Phone:787-565-5480
Mailing Address - Fax:
Practice Address - Street 1:11921 WATER RUN ALY
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-0235
Practice Address - Country:US
Practice Address - Phone:407-777-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1394133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education