MEDICARE: FLAVORFUEL, 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	133NN1002X	Nutrition Education Nutritionist
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1538950779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAVORFUEL, LLC

Provider Business Mailing Address
First Line	:	4050 MEREDITH WOODS LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-6975
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 MEREDITH WOODS LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-6975
Country	:	US
Telephone Number	:	336-705-4415
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & CEO
Name	:	MARCHENE THOMAS
Credential	:
Telephone Number	:	336-705-4415

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/17/2025

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Directions to “FLAVORFUEL, LLC ” Practice Location

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