Healthcare Provider Details

I. General information

NPI: 1700629698
Provider Name (Legal Business Name): SEASONUP NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SANDY SPRING RD SUITE 300 PMB 1005
LAUREL MD
20707
US

IV. Provider business mailing address

8101 SANDY SPRING RD SUITE 300 PMB 1005
LAUREL MD
20707
US

V. Phone/Fax

Practice location:
  • Phone: 443-718-0628
  • Fax:
Mailing address:
  • Phone: 443-718-0628
  • 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: SCHILENCHY GOLDSON
Title or Position: OWNER
Credential: RD
Phone: 443-718-0628