Provider Demographics
NPI:1295367811
Name:LEVY, ORLY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ORLY
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SE 5TH AVE APT 1002
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2970
Mailing Address - Country:US
Mailing Address - Phone:954-651-1606
Mailing Address - Fax:
Practice Address - Street 1:511 SE 5TH AVE APT 1002
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2970
Practice Address - Country:US
Practice Address - Phone:954-651-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86114038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered