Provider Demographics
NPI:1801422985
Name:KYLEE PEDROSA NUTRITION AND WELLNESS LLC
Entity type:Organization
Organization Name:KYLEE PEDROSA NUTRITION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-644-4395
Mailing Address - Street 1:24 WOODSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-7014
Mailing Address - Country:US
Mailing Address - Phone:316-644-4395
Mailing Address - Fax:
Practice Address - Street 1:24 WOODSTONE DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-7014
Practice Address - Country:US
Practice Address - Phone:316-644-4395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty