Provider Demographics
NPI:1063160455
Name:VERO NUTRITION WELLNESS, LLC
Entity type:Organization
Organization Name:VERO NUTRITION WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/GEN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N
Authorized Official - Phone:305-788-1714
Mailing Address - Street 1:2711 N HIGHWAY A1A UNIT D
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34949-1569
Mailing Address - Country:US
Mailing Address - Phone:305-788-1714
Mailing Address - Fax:772-402-3462
Practice Address - Street 1:2711 N HIGHWAY A1A UNIT D
Practice Address - Street 2:
Practice Address - City:HUTCHINSON ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34949-1569
Practice Address - Country:US
Practice Address - Phone:305-788-1714
Practice Address - Fax:772-402-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty