Provider Demographics
NPI:1245653971
Name:PAWELKOSKI, ABBI (RDN,LDN)
Entity type:Individual
Prefix:
First Name:ABBI
Middle Name:
Last Name:PAWELKOSKI
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13448 COLUMBINE AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8144
Mailing Address - Country:US
Mailing Address - Phone:561-315-2335
Mailing Address - Fax:866-204-9911
Practice Address - Street 1:10115 FOREST HILL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3105
Practice Address - Country:US
Practice Address - Phone:561-315-2335
Practice Address - Fax:866-204-9911
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001098133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered