MEDICARE: MS. KELLY KRIKHELY RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1912346511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY KRIKHELY RD

Provider Business Mailing Address
First Line	:	111-17A QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5594
Country	:	US
Telephone Number	:	718-261-8890
Fax Number	:

Provider Business Practice Location Address
First Line	:	111-17A QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5553
Country	:	US
Telephone Number	:	718-261-8890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	02/21/2014

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