Provider Demographics
NPI:1497456255
Name:SCHLOTT, THERESA MARIE (MS, RDN, LDN, CDCES)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:SCHLOTT
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 GULFPORT BLVD S STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2156
Mailing Address - Country:US
Mailing Address - Phone:716-785-0123
Mailing Address - Fax:
Practice Address - Street 1:500 DR MARTIN LUTHER KING JR ST N STE 402
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1472
Practice Address - Country:US
Practice Address - Phone:727-820-7618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7040133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered