Provider Demographics
NPI:1851920714
Name:STELLAR HEALTH NUTRITION, LLC
Entity type:Organization
Organization Name:STELLAR HEALTH NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:202-509-3860
Mailing Address - Street 1:4701 SANGAMORE RD
Mailing Address - Street 2:STE 100N PMB 1162
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1511
Mailing Address - Country:US
Mailing Address - Phone:301-304-7858
Mailing Address - Fax:833-703-0207
Practice Address - Street 1:4701 SANGAMORE RD STE 100N1162
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2508
Practice Address - Country:US
Practice Address - Phone:301-304-7858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health