Provider Demographics
NPI:1699473769
Name:UNMASKED NUTRITION LLC
Entity type:Organization
Organization Name:UNMASKED NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, LDN
Authorized Official - Phone:828-820-5455
Mailing Address - Street 1:125 S LEXINGTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3661
Mailing Address - Country:US
Mailing Address - Phone:828-820-5455
Mailing Address - Fax:
Practice Address - Street 1:125 S LEXINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3661
Practice Address - Country:US
Practice Address - Phone:828-820-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty