Healthcare Provider Details

I. General information

NPI: 1447705496
Provider Name (Legal Business Name): KELLI SZYMANSKI RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12786 ELMFAIR CT
FISHERS IN
46037-9020
US

IV. Provider business mailing address

12786 ELMFAIR CT
FISHERS IN
46037-9020
US

V. Phone/Fax

Practice location:
  • Phone: 317-403-6029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001930A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: