Healthcare Provider Details

I. General information

NPI: 1336756493
Provider Name (Legal Business Name): BALANCED NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RESEARCH PKWY STE 2
WALLINGFORD CT
06492-1929
US

IV. Provider business mailing address

95 SCENIC VIEW DR
MIDDLETOWN CT
06457-4920
US

V. Phone/Fax

Practice location:
  • Phone: 860-351-3144
  • Fax: 833-734-1474
Mailing address:
  • Phone: 860-214-7759
  • 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: REBECCA BALEMIAN
Title or Position: OWNER/REGISTERED DIETITIAN
Credential: RD
Phone: 860-214-7759