Healthcare Provider Details

I. General information

NPI: 1235076647
Provider Name (Legal Business Name): YELIZAVETA SCOTT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7743 SW 99TH ST APT 15
MIAMI FL
33156-2753
US

IV. Provider business mailing address

7743 SW 99TH ST APT 15
MIAMI FL
33156-2753
US

V. Phone/Fax

Practice location:
  • Phone: 561-339-1391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1045322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: