Healthcare Provider Details

I. General information

NPI: 1568060903
Provider Name (Legal Business Name): APPLE WELLNESS AND NUTRITION CENTER. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 WHEATLAND RD
BALTIMORE MD
21228-2762
US

IV. Provider business mailing address

6132 WHEATLAND RD
BALTIMORE MD
21228-2762
US

V. Phone/Fax

Practice location:
  • Phone: 347-967-7243
  • Fax: 410-788-1086
Mailing address:
  • Phone: 347-967-7243
  • Fax: 410-788-1086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: SHOBHA NANDIVADA
Title or Position: OWNER/PROVIDER
Credential: RD,CDE,IFNCP
Phone: 347-982-4372