Healthcare Provider Details

I. General information

NPI: 1619602992
Provider Name (Legal Business Name): PEACEMEAL NUTRITION THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 W HIGHWAY 50 STE 2
O FALLON IL
62269-1856
US

IV. Provider business mailing address

680 ATALANTA AVE
WEBSTER GROVES MO
63119-1949
US

V. Phone/Fax

Practice location:
  • Phone: 708-762-0687
  • Fax: 833-536-1783
Mailing address:
  • Phone:
  • 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: CHRISTINE SINAK
Title or Position: OWNER
Credential: RD
Phone: 314-717-9109