Provider Demographics
NPI:1508573726
Name:THE NUTRITION STUDIO, LLC
Entity Type:Organization
Organization Name:THE NUTRITION STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHEARD-WALWYN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:917-755-8223
Mailing Address - Street 1:73 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1916
Mailing Address - Country:US
Mailing Address - Phone:917-755-8223
Mailing Address - Fax:
Practice Address - Street 1:8 HILLSIDE AVE STE 207-2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2129
Practice Address - Country:US
Practice Address - Phone:973-433-6730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service