Provider Demographics
NPI:1063172559
Name:MY SUGAR COACH LLC
Entity type:Organization
Organization Name:MY SUGAR COACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JALILI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CDCES
Authorized Official - Phone:801-702-3278
Mailing Address - Street 1:9690 S 300 W FL 3
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9690 S 300 W FL 3
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3340
Practice Address - Country:US
Practice Address - Phone:801-702-3278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty