Provider Demographics
NPI:1982075784
Name:PORTER-LUKE, AYLEEN (MA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:AYLEEN
Middle Name:
Last Name:PORTER-LUKE
Suffix:
Gender:F
Credentials:MA, RDN, LDN
Other - Prefix:
Other - First Name:AYLEEN
Other - Middle Name:MARIAN
Other - Last Name:LUKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:145 MARTIN CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1708
Mailing Address - Country:US
Mailing Address - Phone:917-482-6161
Mailing Address - Fax:
Practice Address - Street 1:145 MARTIN CIR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1708
Practice Address - Country:US
Practice Address - Phone:917-482-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6990133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist