Individual
CARLY FANCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RDN, LD/N
Contact information
Practice address
4180 N ORION BLVD BLDG 77, ORLANDO, FL 32816-8029
(336) 905-5966
Mailing address
2360 MAJESTIC BAY LN APT 406, WINTER SPRINGS, FL 32708-3155
(336) 905-5966
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND7308
FL
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
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Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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