Provider Demographics
NPI:1275000622
Name:NUTRITION DISCOVERD, LLC
Entity Type:Organization
Organization Name:NUTRITION DISCOVERD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:903-262-4493
Mailing Address - Street 1:100 N CENTRAL EXPY STE 409
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5311
Mailing Address - Country:US
Mailing Address - Phone:903-262-4493
Mailing Address - Fax:
Practice Address - Street 1:100 N CENTRAL EXPY STE 409
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5311
Practice Address - Country:US
Practice Address - Phone:903-262-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty