Healthcare Provider Details

I. General information

NPI: 1902206634
Provider Name (Legal Business Name): CELESTE PANELY M.S. R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 SW WHISPERING SOUND DR
PALM CITY FL
34990-7735
US

IV. Provider business mailing address

3725 SW WHISPERING SOUND DR
PALM CITY FL
34990-7735
US

V. Phone/Fax

Practice location:
  • Phone: 619-992-3943
  • Fax:
Mailing address:
  • Phone: 619-992-3943
  • Fax: 619-566-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number876458
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND9209
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number876458
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberND9209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: