Provider Demographics
NPI:1285664342
Name:ALEMAN, KELLY C (LD RD CDE)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:C
Last Name:ALEMAN
Suffix:
Gender:F
Credentials:LD RD CDE
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-725-4500
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1223 GATEWAY DR # 1F
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-725-4500
Practice Address - Fax:321-409-5270
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2844133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005515OtherAMERICAN DIABETES ASSOCIATION DIABETIC EDUCATION CERTIFICATION NUMBER
FL005515OtherAMERICAN DIABETES ASSOCIATION DIABETIC EDUCATION CERTIFICATION NUMBER