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NPI Code Detail

MEDICARE: SIMPLY YOU NUTRITION, PLLC

MEDICARE: SIMPLY YOU NUTRITION, PLLC
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
1133V00000XRegistered Dietitian1938OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11811498058OTHERPERSONAL NPI

General Provider Information

NPI Number : 1841780541
Entity Type Code : Organization
Provider Name (Legal Business Name) : SIMPLY YOU NUTRITION, PLLC
Provider Business Mailing Address
First Line : 4815 S HARVARD AVE STE 253
Second Line :
City : TULSA
State : OK
Zip : 74135-3066
Country : US
Telephone Number : 918-280-9418
Fax Number : 539-664-9824
Provider Business Practice Location Address
First Line : 7633 E 63RD PL STE 300
Second Line :
City : TULSA
State : OK
Zip : 74133-1202
Country : US
Telephone Number : 918-280-9418
Fax Number : 539-664-9824
Authorized Official
Title or Position : REGISTERED DIETITIAN
Name : SYDNEY CAVERO-EGUSQUIZA
Credential : MS, RD/LD
Telephone Number : 918-280-9418
Provider Enumeration Date : 05/17/2018
Last Update Date : 01/29/2023

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Directions to “SIMPLY YOU NUTRITION, PLLC ” Practice Location

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