Provider Demographics
NPI:1336156918
Name:NUTRITIONALLY SPEAKING
Entity Type:Organization
Organization Name:NUTRITIONALLY SPEAKING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CONSULTING DIETITIAN DIABETES
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENEE ROHT
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD CDE CDN
Authorized Official - Phone:302-678-4909
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:NUTRITIONALLY SPEAKING
Mailing Address - City:CHESWOLD
Mailing Address - State:DE
Mailing Address - Zip Code:19936
Mailing Address - Country:US
Mailing Address - Phone:302-678-4909
Mailing Address - Fax:302-678-4944
Practice Address - Street 1:9 E LOOCKERMAN ST
Practice Address - Street 2:STE 316 NUTRITIONALLY SPEAKING
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-678-4909
Practice Address - Fax:302-678-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN0000116133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034569Medicaid
DE1000034569Medicaid