Provider Demographics
NPI:1275060394
Name:SELENT, RACHAEL H (RD LD)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:H
Last Name:SELENT
Suffix:
Gender:F
Credentials:RD LD
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Mailing Address - Street 1:23263 HARBORVIEW RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2180
Mailing Address - Country:US
Mailing Address - Phone:941-743-6666
Mailing Address - Fax:941-743-5868
Practice Address - Street 1:23263 HARBORVIEW RD STE 1
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2180
Practice Address - Country:US
Practice Address - Phone:941-743-6666
Practice Address - Fax:941-743-5868
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLND810133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
12055OtherCOMMISSION ON DIETETIC REGISTRATION
FLND810OtherDEPARTMENT OF HEALTH STATE OF FL