Provider Demographics
NPI:1629548086
Name:SMART NUTRITION, LLC
Entity Type:Organization
Organization Name:SMART NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:917-862-0454
Mailing Address - Street 1:2206 E LEIGH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7228
Mailing Address - Country:US
Mailing Address - Phone:347-688-8026
Mailing Address - Fax:
Practice Address - Street 1:2727 ENTERPRISE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-6341
Practice Address - Country:US
Practice Address - Phone:804-864-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty