Provider Demographics
NPI:1457016073
Name:SECRET SAUCE NUTRITION
Entity Type:Organization
Organization Name:SECRET SAUCE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:STAR
Authorized Official - Last Name:MAGGIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:201-458-4065
Mailing Address - Street 1:249 WINTHROP SHORE DR APT 5
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1153
Mailing Address - Country:US
Mailing Address - Phone:201-458-4065
Mailing Address - Fax:
Practice Address - Street 1:249 WINTHROP SHORE DR APT 5
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1153
Practice Address - Country:US
Practice Address - Phone:201-458-4065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty