Healthcare Provider Details

I. General information

NPI: 1831910918
Provider Name (Legal Business Name): KELLY CARVALHO MS,CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 687
WAREHAM MA
02571-0687
US

IV. Provider business mailing address

PO BOX 687
WAREHAM MA
02571-0687
US

V. Phone/Fax

Practice location:
  • Phone: 774-257-5044
  • Fax:
Mailing address:
  • Phone: 774-257-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLDN7766
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN7766
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: