Provider Demographics
NPI:1891562609
Name:TRAUTWEIN, ILEANA (RD)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:
Last Name:TRAUTWEIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 RED BUG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7154
Mailing Address - Country:US
Mailing Address - Phone:407-381-7345
Mailing Address - Fax:407-636-7820
Practice Address - Street 1:7416 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7154
Practice Address - Country:US
Practice Address - Phone:407-977-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered