Provider Demographics
NPI:1013497163
Name:SELVEY, ASHLEY LEIGH (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LEIGH
Last Name:SELVEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ELM AVE SE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5613
Mailing Address - Country:US
Mailing Address - Phone:480-734-1421
Mailing Address - Fax:
Practice Address - Street 1:5 ELM AVE SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5613
Practice Address - Country:US
Practice Address - Phone:480-734-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8253133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered