MEDICARE: NUTRITIOUS SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1093662199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITIOUS SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	41 MILLENNIUM LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-4337
Country	:	US
Telephone Number	:	917-615-9076
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 MILLENNIUM LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-4337
Country	:	US
Telephone Number	:	917-544-4393
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN
Name	:	HAIDY YOUSSEF
Credential	:	CDN
Telephone Number	:	917-615-9076

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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