Provider Demographics
NPI:1275866055
Name:NUTRITION AND DIABETES EDUCATION CENTER, LLC
Entity Type:Organization
Organization Name:NUTRITION AND DIABETES EDUCATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:HAWKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-805-8292
Mailing Address - Street 1:12150 ANNAPOLIS RD.
Mailing Address - Street 2:STE. 104
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769
Mailing Address - Country:US
Mailing Address - Phone:301-805-8292
Mailing Address - Fax:301-352-0405
Practice Address - Street 1:12150 ANNAPOLIS RD
Practice Address - Street 2:STE 104
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:301-805-8292
Practice Address - Fax:301-352-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01715133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491662Medicare PIN