Provider Demographics
NPI:1689326035
Name:CAMILO, KELSY (RDN)
Entity Type:Individual
Prefix:
First Name:KELSY
Middle Name:
Last Name:CAMILO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 WHEELER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5509
Mailing Address - Country:US
Mailing Address - Phone:917-645-7390
Mailing Address - Fax:
Practice Address - Street 1:511 WEST 157TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5058
Practice Address - Country:US
Practice Address - Phone:212-781-7979
Practice Address - Fax:212-781-7963
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered