Provider Demographics
NPI:1316282353
Name:HARRELL, ALLISON (RDN, CCMS)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:RDN, CCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 DARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4739
Mailing Address - Country:US
Mailing Address - Phone:321-438-6444
Mailing Address - Fax:
Practice Address - Street 1:129 NW 13TH ST STE 20
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1635
Practice Address - Country:US
Practice Address - Phone:321-438-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT91251133V00000X
FLND3636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered