Provider Demographics
NPI:1093587107
Name:WEST CHESTER NUTRITION GROUP LLC
Entity Type:Organization
Organization Name:WEST CHESTER NUTRITION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:LEASK
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:215-932-6789
Mailing Address - Street 1:18 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3240
Mailing Address - Country:US
Mailing Address - Phone:215-932-6789
Mailing Address - Fax:
Practice Address - Street 1:18 CAMPUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3240
Practice Address - Country:US
Practice Address - Phone:215-932-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty