Provider Demographics
NPI:1891437901
Name:DIETITIAN DUO
Entity Type:Organization
Organization Name:DIETITIAN DUO
Other - Org Name:MICHAEL HERSHEY NUTRITION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:440-823-6380
Mailing Address - Street 1:2801 BARBER AVE APT 4302
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-4773
Mailing Address - Country:US
Mailing Address - Phone:440-823-6380
Mailing Address - Fax:
Practice Address - Street 1:25846 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA STATION
Practice Address - State:OH
Practice Address - Zip Code:44028-9441
Practice Address - Country:US
Practice Address - Phone:440-823-6380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-09
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service