Provider Demographics
NPI:1154605103
Name:EAT TO LIVE
Entity type:Organization
Organization Name:EAT TO LIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:401-486-7089
Mailing Address - Street 1:195 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2610
Mailing Address - Country:US
Mailing Address - Phone:401-486-7089
Mailing Address - Fax:401-619-0949
Practice Address - Street 1:195 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2610
Practice Address - Country:US
Practice Address - Phone:401-486-7089
Practice Address - Fax:401-619-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty