Provider Demographics
NPI:1730233958
Name:MECOLI, ALICE A (RD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:A
Last Name:MECOLI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21915 LAKE FOREST CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3375
Mailing Address - Country:US
Mailing Address - Phone:561-305-0004
Mailing Address - Fax:
Practice Address - Street 1:21915 LAKE FOREST CIR APT 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3375
Practice Address - Country:US
Practice Address - Phone:561-305-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3388133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered