Provider Demographics
NPI:1689942955
Name:TARA GIDUS NUTRITION CONSULTING
Entity Type:Organization
Organization Name:TARA GIDUS NUTRITION CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSSD, LDN
Authorized Official - Phone:321-287-8834
Mailing Address - Street 1:1350 ORANGE AVE
Mailing Address - Street 2:SUITE 232
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4945
Mailing Address - Country:US
Mailing Address - Phone:321-287-8834
Mailing Address - Fax:
Practice Address - Street 1:1350 ORANGE AVE
Practice Address - Street 2:SUITE 232
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4945
Practice Address - Country:US
Practice Address - Phone:321-287-8834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty