Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 130008 | FL |
N | 207YS0123X | Facial Plastic Surgeon | 130008 | FL |
NPI | 1225473267 |
---|---|
Provider Name | Dr. Renata Khelemsky |
First Address | Melbourne, FL 32935-5958 |
Second Address | Melbourne, FL 32935-5958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2013 |
Last Update Date | 14/05/2020 |