Provider Demographics
NPI:1104578822
Name:THE NUTRITION SUITE LLC
Entity type:Organization
Organization Name:THE NUTRITION SUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD CDN
Authorized Official - Phone:914-294-5533
Mailing Address - Street 1:360 E 88TH ST APT 17D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:370 LEXINGTON AVE RM 1900
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6577
Practice Address - Country:US
Practice Address - Phone:914-294-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891160370OtherINDIVIDUAL NPI