Healthcare Provider Details

I. General information

NPI: 1811126980
Provider Name (Legal Business Name): TKS NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 MANCHESTER WAY
MIDDLETOWN DE
19709-2132
US

IV. Provider business mailing address

244 MANCHESTER WAY
MIDDLETOWN DE
19709-2132
US

V. Phone/Fax

Practice location:
  • Phone: 302-897-2088
  • Fax: 302-376-9261
Mailing address:
  • Phone: 302-897-2088
  • Fax: 302-376-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number208206179
License Number StateDE

VIII. Authorized Official

Name: TRACEY K SINIBALDI
Title or Position: OWNER/ REGISTERED DIETITIAN
Credential: RD
Phone: 302-897-2088