Healthcare Provider Details

I. General information

NPI: 1134173255
Provider Name (Legal Business Name): BETSY OPYT R.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

PO BOX 277575
ATLANTA GA
30384-7575
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4000
  • Fax:
Mailing address:
  • Phone: 239-348-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND4522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: