Provider Demographics
NPI:1841780541
Name:SIMPLY YOU NUTRITION, PLLC
Entity type:Organization
Organization Name:SIMPLY YOU NUTRITION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVERO-EGUSQUIZA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD/LD
Authorized Official - Phone:918-280-9418
Mailing Address - Street 1:4815 S HARVARD AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3066
Mailing Address - Country:US
Mailing Address - Phone:918-280-9418
Mailing Address - Fax:539-664-9824
Practice Address - Street 1:7633 E 63RD PL STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1202
Practice Address - Country:US
Practice Address - Phone:918-280-9418
Practice Address - Fax:539-664-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1938133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1811498058OtherPERSONAL NPI