Provider Demographics
NPI:1629004718
Name:LEE, JOANIE K (RD, LD)
Entity Type:Individual
Prefix:
First Name:JOANIE
Middle Name:K
Last Name:LEE
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 1:601 E ROLLINS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1248
Mailing Address - Country:US
Mailing Address - Phone:407-303-8150
Mailing Address - Fax:407-303-1573
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-8150
Practice Address - Fax:407-303-1573
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA918558133V00000X
FLND5527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0209183OtherL&I PIN
WA8451320Medicaid
WA39568UOtherREGENCE BLUE SHIELD PIN
WA0209183OtherL&I PIN