Healthcare Provider Details

I. General information

NPI: 1275866055
Provider Name (Legal Business Name): NUTRITION AND DIABETES EDUCATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 104
GLENN DALE MD
20769-9183
US

IV. Provider business mailing address

12150 ANNAPOLIS RD. STE. 104
GLENN DALE MD
20769
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-8292
  • Fax: 301-352-0405
Mailing address:
  • Phone: 301-805-8292
  • Fax: 301-352-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD01715
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberD01715
License Number StateMD

VIII. Authorized Official

Name: MRS. SHARON EVETTE HAWKS
Title or Position: OWNER, DIRECTOR
Credential:
Phone: 301-805-8292