Provider Demographics
NPI:1295358174
Name:SUSTAINABLE NOURISHMENT NUTRITION THERAPY, LLC
Entity Type:Organization
Organization Name:SUSTAINABLE NOURISHMENT NUTRITION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMISCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:214-491-9346
Mailing Address - Street 1:11807 WESTHEIMER ROAD
Mailing Address - Street 2:SUITE 550 PMB 641
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:214-491-9346
Mailing Address - Fax:
Practice Address - Street 1:3805 W ALABAMA ST APT 4107
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5248
Practice Address - Country:US
Practice Address - Phone:214-491-9346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty