Provider Demographics
NPI:1285478347
Name:FERRIL-MARLEY, KELEESHA (RDN)
Entity type:Individual
Prefix:
First Name:KELEESHA
Middle Name:
Last Name:FERRIL-MARLEY
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 1:1015 MILDRED DIXON WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2940
Mailing Address - Country:US
Mailing Address - Phone:301-254-6899
Mailing Address - Fax:
Practice Address - Street 1:1015 MILDRED DIXON WAY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2940
Practice Address - Country:US
Practice Address - Phone:301-254-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND13075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty