Provider Demographics
NPI:1255946331
Name:NUTRISHED DIETITIAN NUTRITION SOLUTIONS, P.C.
Entity type:Organization
Organization Name:NUTRISHED DIETITIAN NUTRITION SOLUTIONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT-HAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:929-345-4730
Mailing Address - Street 1:2825 3RD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4066
Mailing Address - Country:US
Mailing Address - Phone:929-345-4730
Mailing Address - Fax:
Practice Address - Street 1:2825 THIRD AVE SUITE #301
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:929-345-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty