Provider Demographics
NPI:1376276196
Name:PIVOT NUTRITION LLC
Entity Type:Organization
Organization Name:PIVOT NUTRITION LLC
Other - Org Name:PIVOT NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:410-914-7610
Mailing Address - Street 1:260 GATEWAY DR STE 9C
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4168
Mailing Address - Country:US
Mailing Address - Phone:410-914-7610
Mailing Address - Fax:443-773-5504
Practice Address - Street 1:260 GATEWAY DR STE 9C
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4168
Practice Address - Country:US
Practice Address - Phone:301-404-1884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty