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General NPI Number Information
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NPI Number | 1659233526
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Entity Type | Organization
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Legal Business Name | MY BRIGHT NUTRITION LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 3600 MYSTIC POINTE DR APT 1112
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City | AVENTURA
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State | FL
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Zip | 33180-2561
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Country | US
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Telephone | 786-818-9609
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 786-818-9609
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Fax |
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Authorized Official
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Title or Position | OWNER / REGISTERED DIETITIAN
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Name | KELLY EZAGURY
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Credential | RDN
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Telephone | 786-818-9609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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