Healthcare Provider Details

I. General information

NPI: 1245873470
Provider Name (Legal Business Name): MARIA KHALED RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N ORANGE AVE STE 847
ORLANDO FL
32801-2316
US

IV. Provider business mailing address

111 N ORANGE AVE STE 847
ORLANDO FL
32801-2316
US

V. Phone/Fax

Practice location:
  • Phone: 407-698-3121
  • Fax:
Mailing address:
  • Phone: 407-698-3121
  • Fax: 407-698-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberLDN0000003646
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: