Provider Demographics
NPI:1811126980
Name:TKS NUTRITION, LLC
Entity type:Organization
Organization Name:TKS NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINIBALDI
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:302-897-2088
Mailing Address - Street 1:244 MANCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2132
Mailing Address - Country:US
Mailing Address - Phone:302-897-2088
Mailing Address - Fax:302-376-9261
Practice Address - Street 1:244 MANCHESTER WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-2132
Practice Address - Country:US
Practice Address - Phone:302-897-2088
Practice Address - Fax:302-376-9261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE208206179261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center