Provider Demographics
NPI:1639697667
Name:MARY DYE NUTRITION, LLC
Entity Type:Organization
Organization Name:MARY DYE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CEDRD, LD/N
Authorized Official - Phone:646-593-2407
Mailing Address - Street 1:2237 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1398
Mailing Address - Country:US
Mailing Address - Phone:646-593-2407
Mailing Address - Fax:
Practice Address - Street 1:1 COLUMBUS CTR STE 600
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6760
Practice Address - Country:US
Practice Address - Phone:757-333-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00963080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty