Healthcare Provider Details

I. General information

NPI: 1609583004
Provider Name (Legal Business Name): HEATHER BEHR PHD, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 W FAIRBANKS AVE STE B
WINTER PARK FL
32789-4578
US

IV. Provider business mailing address

1724 GURTLER CT APT 3
ORLANDO FL
32804-6428
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-1775
  • Fax:
Mailing address:
  • Phone: 407-350-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number11692
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number11692
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number11692
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number11692
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number11692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: