Healthcare Provider Details

I. General information

NPI: 1477208262
Provider Name (Legal Business Name): KEJSI XHARO MS, RDN, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 72ND ST APT 6L
BROOKLYN NY
11209-2007
US

IV. Provider business mailing address

130 72ND ST APT 6L
BROOKLYN NY
11209-2007
US

V. Phone/Fax

Practice location:
  • Phone: 347-552-4079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number010145
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: