Healthcare Provider Details

I. General information

NPI: 1003953597
Provider Name (Legal Business Name): KELLY MARIE FERNANDEZ ROJAS RD/LD, CBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD STE 302
MELBOURNE FL
32940-2240
US

IV. Provider business mailing address

212 BOSSIEUX BLVD
MELBOURNE FL
32904-4948
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9230
  • Fax:
Mailing address:
  • Phone: 305-799-4569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: