Healthcare Provider Details

I. General information

NPI: 1205746385
Provider Name (Legal Business Name): COMMUNITY PLATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 POLK ST # X220254
HOLLYWOOD FL
33022-0010
US

IV. Provider business mailing address

1801 POLK ST # X220254
HOLLYWOOD FL
33022-0010
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-3048
  • Fax:
Mailing address:
  • Phone: 954-399-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: NICHELLE SHEARER
Title or Position: OWNER
Credential: B.S
Phone: 954-399-3048