Healthcare Provider Details

I. General information

NPI: 1386101830
Provider Name (Legal Business Name): CASSANDRA SUAREZ NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 ROSENA DR
CHARLOTTE NC
28227-3007
US

IV. Provider business mailing address

4904 ROSENA DR
CHARLOTTE NC
28227-3007
US

V. Phone/Fax

Practice location:
  • Phone: 651-243-2584
  • Fax:
Mailing address:
  • Phone:
  • 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: CASSANDRA ANNE SUAREZ
Title or Position: REGISTERED DIETITIAN/OWNER
Credential: MS, RDN, LDN, CPT
Phone: 978-376-0458