Provider Demographics
NPI:1992558266
Name:MCINTYRE, ASHLEY H
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:H
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15434 BLACKMOOR TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2107
Mailing Address - Country:US
Mailing Address - Phone:941-465-9590
Mailing Address - Fax:
Practice Address - Street 1:15434 BLACKMOOR TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2107
Practice Address - Country:US
Practice Address - Phone:941-357-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist