Provider Demographics
NPI:1831910918
Name:CARVALHO, KELLY (MS,CNS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CARVALHO
Suffix:
Gender:F
Credentials:MS,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-0687
Mailing Address - Country:US
Mailing Address - Phone:774-257-5044
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 687
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-0687
Practice Address - Country:US
Practice Address - Phone:774-257-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN7766133V00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered