Provider Demographics
NPI:1316564693
Name:NUTRITION SPECIALISTS GROUP LLC
Entity Type:Organization
Organization Name:NUTRITION SPECIALISTS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ZACHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, LDN
Authorized Official - Phone:407-491-2614
Mailing Address - Street 1:172 E LAKE MARY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3046
Mailing Address - Country:US
Mailing Address - Phone:321-234-4045
Mailing Address - Fax:844-955-2508
Practice Address - Street 1:172 E LAKE MARY AVE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3046
Practice Address - Country:US
Practice Address - Phone:321-234-4045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Single Specialty