Healthcare Provider Details

I. General information

NPI: 1447014089
Provider Name (Legal Business Name): OPTIMAL NUTRITION EXPERTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE 5328
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

2200 N COMMERCE PKWY STE 200
WESTON FL
33326-3258
US

V. Phone/Fax

Practice location:
  • Phone: 954-357-3180
  • Fax: 954-317-9515
Mailing address:
  • Phone: 954-357-3180
  • Fax: 954-317-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: YESENIA CHEDIAK
Title or Position: AMBR
Credential:
Phone: 786-704-7496