Active NPI
Maureen Patricia Wallace, R.D.
- Registered Dietitian
- Dunedin, FL
National Provider Identifier
1790722015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- ND4693
- Practice address
- 753 Virginia St
Dunedin, FL 34698-6615 - Phone
- (727) 734-6888
- Fax
- (727) 734-6898
- NPI assigned
- Jun 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | ND4693 | FL | Primary |
Addresses
Primary practice location
753 Virginia St
Dunedin, FL 34698-6615
Mailing address
PO Box 1698
Clearwater, FL 33757-1698
Phone (727) 532-0002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ND4693 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MPM Specialists LLC | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281052800000",
"number": "1790722015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1698",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337571698",
"telephone_number": "727-532-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "753 VIRGINIA ST",
"city": "DUNEDIN",
"state": "FL",
"postal_code": "346986615",
"telephone_number": "727-734-6888",
"fax_number": "727-734-6898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MAUREEN",
"middle_name": "PATRICIA",
"name_prefix": "Ms.",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-02",
"last_updated": "2010-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "ND4693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dunedin, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.