Healthcare Provider Details

I. General information

NPI: 1619086758
Provider Name (Legal Business Name): SSS NUTRITION AND DIETETIC CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST SUITE 934
SILVER SPRING MD
20910-3806
US

IV. Provider business mailing address

PO BOX 8336
SILVER SPRING MD
20907-8336
US

V. Phone/Fax

Practice location:
  • Phone: 301-588-4440
  • Fax: 301-588-1011
Mailing address:
  • Phone: 301-588-4440
  • Fax: 301-588-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberB00222
License Number StateMD

VIII. Authorized Official

Name: MRS. OLUSOLA IDOWU
Title or Position: DIRECTOR/CHIEF NUTRITION SPECIALIST
Credential: MS, RD, LD, LN
Phone: 301-588-4440