Provider Demographics
NPI:1376014324
Name:SCHEESE, KYLA (RDN, LD, CEDS, CPT)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:SCHEESE
Suffix:
Gender:F
Credentials:RDN, LD, CEDS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 BROOMFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1956
Mailing Address - Country:US
Mailing Address - Phone:248-766-9627
Mailing Address - Fax:
Practice Address - Street 1:4758 BROOMFIELD WAY
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1956
Practice Address - Country:US
Practice Address - Phone:248-766-9627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN133V00000X
MI86084767133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A