Provider Demographics
NPI:1992203483
Name:SHANTI NUTRITION LLC
Entity Type:Organization
Organization Name:SHANTI NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:774-722-2152
Mailing Address - Street 1:8 EDGAR CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1409
Mailing Address - Country:US
Mailing Address - Phone:774-722-2152
Mailing Address - Fax:
Practice Address - Street 1:8 EDGAR CT UNIT 2
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1409
Practice Address - Country:US
Practice Address - Phone:774-722-2152
Practice Address - Fax:833-232-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty