Healthcare Provider Details

I. General information

NPI: 1356120604
Provider Name (Legal Business Name): ENJOY MOORE NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 TRIPHAMMER RD
HINGHAM MA
02043-2984
US

IV. Provider business mailing address

9 TRIPHAMMER RD
HINGHAM MA
02043-2984
US

V. Phone/Fax

Practice location:
  • Phone: 617-899-1550
  • Fax:
Mailing address:
  • Phone: 617-899-1550
  • 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: KELLY MOORE
Title or Position: OWNER
Credential: RDN
Phone: 617-899-1550