Healthcare Provider Details

I. General information

NPI: 1902515521
Provider Name (Legal Business Name): VIDA EATS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 16TH AVE S
ST PETERSBURG FL
33701-5407
US

IV. Provider business mailing address

699 16TH AVE S
ST PETERSBURG FL
33701-5407
US

V. Phone/Fax

Practice location:
  • Phone: 860-944-0232
  • Fax:
Mailing address:
  • Phone: 860-944-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ALANA BENITO
Title or Position: CEO
Credential: RD
Phone: 860-944-0232