Provider Demographics
NPI:1780223032
Name:HAPPY VALLEY NUTRITION PC
Entity Type:Organization
Organization Name:HAPPY VALLEY NUTRITION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:917-626-1027
Mailing Address - Street 1:3 PHILLIPS PL
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3515
Mailing Address - Country:US
Mailing Address - Phone:917-626-1027
Mailing Address - Fax:
Practice Address - Street 1:24 S PROSPECT ST STE 104
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2293
Practice Address - Country:US
Practice Address - Phone:917-626-1027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty