Juan Camilo Camacho Velandia, REGISTER DIETITIAN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND10955 Issued in FL

Practice address

490 N Washington Ave
Titusville, FL 32796-2871

Phone

(321) 268-4200

Fax

(321) 268-1386

NPI assigned

Aug 3, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1366124984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 S FISKE BLVD",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329554306",
            "telephone_number": "321-268-4200",
            "fax_number": "321-268-1386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 N WASHINGTON AVE",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962871",
            "telephone_number": "321-268-4200",
            "fax_number": "321-268-1386"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 Hickory St Ste B",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329011973",
            "country_code": "US",
            "telephone_number": "321-725-4500 x4847",
            "fax_number": "321-952-6179",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "225 Cone Rd",
            "address_purpose": "LOCATION",
            "city": "Merritt Island",
            "state": "FL",
            "postal_code": "329523114",
            "country_code": "US",
            "telephone_number": "321-453-1361",
            "fax_number": "321-452-4939",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8725 N Wickham Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329402240",
            "country_code": "US",
            "telephone_number": "321-253-4673",
            "fax_number": "321-253-4338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMACHO VELANDIA",
        "first_name": "JUAN",
        "middle_name": "CAMILO",
        "credential": "REGISTER DIETITIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND10955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN HF",
            "identifier": "RI498",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Dietitian in Titusville, FL
• Providers in Titusville, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.