Provider Demographics
NPI:1295386001
Name:BE NUTRITION LLC
Entity Type:Organization
Organization Name:BE NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BASHEERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ENAHORA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:704-380-9924
Mailing Address - Street 1:4651 CHARLOTTE PARK DR STE 101C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1916
Mailing Address - Country:US
Mailing Address - Phone:704-380-9924
Mailing Address - Fax:
Practice Address - Street 1:4651 CHARLOTTE PARK DR STE 101C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1916
Practice Address - Country:US
Practice Address - Phone:704-380-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19NJWOtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA