Healthcare Provider Details

I. General information

NPI: 1720967094
Provider Name (Legal Business Name): SK NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 DELMONT ST
MANCHESTER CT
06042-3511
US

IV. Provider business mailing address

31 DELMONT ST
MANCHESTER CT
06042-3511
US

V. Phone/Fax

Practice location:
  • Phone: 860-818-9595
  • Fax:
Mailing address:
  • Phone: 860-818-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SARAH KHAN
Title or Position: OWNER/REGISTERED DIETITIAN
Credential: MS, RD, CDN
Phone: 860-818-9595