Provider Demographics
NPI:1568266096
Name:FRESH START- DIETITIAN, LLC
Entity type:Organization
Organization Name:FRESH START- DIETITIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD/N
Authorized Official - Phone:240-675-0146
Mailing Address - Street 1:11011 HOFFNER EDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4085
Mailing Address - Country:US
Mailing Address - Phone:240-675-0146
Mailing Address - Fax:
Practice Address - Street 1:6544 US HIGHWAY 41 N SUITE. 209 B
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572
Practice Address - Country:US
Practice Address - Phone:240-675-0146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty