Provider Demographics
NPI:1245469642
Name:ENLIGHTENED RD
Entity type:Organization
Organization Name:ENLIGHTENED RD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOSTREICH
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N
Authorized Official - Phone:941-448-9633
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:941-448-9633
Practice Address - Fax:866-399-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 2941133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty