Provider Demographics
NPI:1700461324
Name:COASTAL NUTRITION LLC
Entity Type:Organization
Organization Name:COASTAL NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEBENI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, RD, LD/N
Authorized Official - Phone:800-970-6862
Mailing Address - Street 1:433 PLAZA REAL STE 275
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3999
Mailing Address - Country:US
Mailing Address - Phone:800-970-6862
Mailing Address - Fax:
Practice Address - Street 1:433 PLAZA REAL STE 275
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3999
Practice Address - Country:US
Practice Address - Phone:800-970-6862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty