Healthcare Provider Details

I. General information

NPI: 1538428099
Provider Name (Legal Business Name): KELLY BRITT URBANIK R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST # MP317
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

92 W MILLER ST
ORLANDO FL
32806-2032
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1179
  • Fax: 321-843-6396
Mailing address:
  • Phone: 321-841-1179
  • Fax: 321-843-6396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND4978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: