Basic Information
| Provider Information | |||||||||
| NPI: | 1275812042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | ASHLEE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MDA, RD, LD/N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218416600 | ||||||||
| FaxNumber: | 3218414085 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218416600 | ||||||||
| FaxNumber: | 3218414085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 48007579 | NY | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133V00000X | ND7187 | FL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | N/A | 05 | FL | MEDICAID | ND7187 | 01 | FL | MEDICAL LICENSE | OTHER |