Provider Demographics
NPI:1710014279
Name:MOUSSEAU, GAYLE MAUDE (RD,LD)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:MAUDE
Last Name:MOUSSEAU
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 1:1139 BAY ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-1828
Mailing Address - Country:US
Mailing Address - Phone:727-502-9547
Mailing Address - Fax:
Practice Address - Street 1:1139 BAY ST NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1828
Practice Address - Country:US
Practice Address - Phone:727-502-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL593147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered