MEDICARE: SM NUTRITION, 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	133VN1501X	Sports Dietetics Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1558174482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SM NUTRITION, LLC

Provider Business Mailing Address
First Line	:	1311 JAMESTOWN RD STE 202
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3391
Country	:	US
Telephone Number	:	757-401-4024
Fax Number	:	757-244-9150

Provider Business Practice Location Address
First Line	:	1311 JAMESTOWN RD STE 202
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3391
Country	:	US
Telephone Number	:	757-401-4024
Fax Number	:	757-244-9150

Authorized Official
Title or Position	:	REGISTERED SPORTS DIETITIAN
Name	:	STEPHANIE MILITANO
Credential	:	MS, RD, CSSD
Telephone Number	:	757-401-4024

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	03/19/2026

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