Provider Demographics
NPI:1316554918
Name:KELLY RASHID RD LLC
Entity Type:Organization
Organization Name:KELLY RASHID RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHID
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:610-310-9581
Mailing Address - Street 1:3070 NE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5806
Mailing Address - Country:US
Mailing Address - Phone:610-310-9581
Mailing Address - Fax:
Practice Address - Street 1:3070 NE 43RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5806
Practice Address - Country:US
Practice Address - Phone:610-310-9581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty