Healthcare Provider Details

I. General information

NPI: 1659233526
Provider Name (Legal Business Name): MY BRIGHT NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MYSTIC POINTE DR APT 1112
AVENTURA FL
33180-2561
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 786-818-9609
  • Fax:
Mailing address:
  • Phone: 786-818-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KELLY EZAGURY
Title or Position: OWNER / REGISTERED DIETITIAN
Credential: RDN
Phone: 786-818-9609