Provider Demographics
NPI:1720220528
Name:KLOSTREICH, PAULETTE (RD, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:
Last Name:KLOSTREICH
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:MARY
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 SW BALD EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-8865
Mailing Address - Country:US
Mailing Address - Phone:941-448-9633
Mailing Address - Fax:866-399-7621
Practice Address - Street 1:6301 SW BALD EAGLE DR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8865
Practice Address - Country:US
Practice Address - Phone:941-761-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 2941133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered