Provider Demographics
NPI:1598170524
Name:EATWELLGURU LLC
Entity Type:Organization
Organization Name:EATWELLGURU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DADKHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD
Authorized Official - Phone:703-665-3814
Mailing Address - Street 1:46165 WESTLAKE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5872
Mailing Address - Country:US
Mailing Address - Phone:703-665-3814
Mailing Address - Fax:703-347-9788
Practice Address - Street 1:46165 WESTLAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5872
Practice Address - Country:US
Practice Address - Phone:703-665-3814
Practice Address - Fax:703-347-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-28
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty